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Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16.48}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6045.85,"maximum":30377.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19968.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18687.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19968.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17701.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16507.14},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15426.41},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8061.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8061.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6045.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30377.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5312.46,"10th_percentile":5312.46,"90th_percentile":5312.46,"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":8962.67,"10th_percentile":8962.67,"90th_percentile":8962.67,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5860.22,"10th_percentile":5860.22,"90th_percentile":5860.22,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":48901.68,"10th_percentile":48901.68,"90th_percentile":48901.68,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6021.14,"maximum":30240.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19878.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18603.4},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19878.44},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17622.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16433.08},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15357.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6021.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30240.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4474.39,"maximum":21707.28,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14268.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13353.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14268.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12649.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11795.87},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11023.58},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5965.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5965.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4474.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21707.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8091.16,"maximum":41661.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27385.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25628.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27385.55},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24277.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22639.04},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21156.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10788.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10788.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8091.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41661.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13428.18,"maximum":71106.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46740.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43742.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46740.71},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41435.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38639.54},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36109.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17904.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17904.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13428.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71106.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13689.8,"maximum":72549.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47689.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44630.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47689.53},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42276.71},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39423.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36842.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18253.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18253.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13689.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72549.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18564.2,"maximum":99442.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65366.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61174.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65366.95},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57947.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54037.45},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50499.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24752.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24752.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18564.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99442.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":38080.29,"maximum":207114.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":136143.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":127411.26},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":136143.83},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120691.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112547.17},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105178.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50773.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50773.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38080.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":207114.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4670.33,"maximum":22788.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14979.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14018.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14979.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13279.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12383.3},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11572.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6227.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6227.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4670.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22788.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":4542.28,"10th_percentile":4542.28,"90th_percentile":4542.28,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":14087.36,"10th_percentile":14087.36,"90th_percentile":14087.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":6058.9,"10th_percentile":6058.9,"90th_percentile":6058.9,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6957.25,"10th_percentile":6957.25,"90th_percentile":6957.25,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4580.5,"maximum":22292.71,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14653.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13713.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14653.81},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12990.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12113.99},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11320.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6107.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6107.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4580.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22292.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7747.56,"maximum":39765.71,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26139.45},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24462.81},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26139.45},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23172.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21608.92},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20194.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7747.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39765.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":26567.03,"10th_percentile":26567.03,"90th_percentile":26567.03,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":21664.87,"10th_percentile":21664.87,"90th_percentile":21664.87,"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 Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7217.32,"10th_percentile":7217.32,"90th_percentile":7217.32,"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":9139.97,"10th_percentile":8208.93,"90th_percentile":11670.18,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7751.36,"10th_percentile":7751.36,"90th_percentile":7751.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10012.85,"10th_percentile":10012.85,"90th_percentile":10012.85,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":23464.44,"10th_percentile":23464.44,"90th_percentile":23464.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11660.78,"maximum":61355.28,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40331.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37744.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40331.07},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35753.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33340.83},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31157.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15547.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15547.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11660.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61355.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":40572.5,"maximum":220864.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":145182.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":135869.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":145182.07},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":128703.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120018.89},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112161.19},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54096.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54096.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40572.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":220864.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":27268.71,"maximum":147465.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":96934.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":90717.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":96934.65},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85932.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80133.79},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74887.38},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36358.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36358.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27268.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147465.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11892.64,"maximum":62634.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41171.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38531.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41171.98},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36498.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34035.99},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31807.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15856.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15856.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11892.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62634.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8930.51,"maximum":46292.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30429.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28477.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30429.51},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26975.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25155.42},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23508.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11907.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11907.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8930.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46292.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":28172.06,"maximum":152449.66,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":100210.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":93782.99},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":100210.73},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88836.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82842.05},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77418.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37562.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37562.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28172.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152449.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":28316.35,"maximum":153245.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":100734.01},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":94272.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":100734.01},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89300.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83274.64},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77822.6},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37755.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37755.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153245.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":32580.46,"maximum":176771.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":116198.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":108744.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":116198.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103009.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96058.54},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89769.54},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43440.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43440.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32580.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176771.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4301.47,"maximum":20753.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13641.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12766.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13641.87},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12093.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11277.44},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10539.1},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5735.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5735.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4301.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20753.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4068.47,"maximum":19467.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12796.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11976.07},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12796.89},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11344.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10578.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9886.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4068.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19467.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":5902.36,"10th_percentile":5902.36,"90th_percentile":5902.36,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6093.01,"maximum":30637.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20139.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18847.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20139.07},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17853.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16648.53},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15558.54},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8124.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8124.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6093.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30637.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4778.68,"maximum":23386.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15372.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14386.53},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15372.56},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13627.75},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12708.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11876.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6371.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6371.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4778.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23386.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":21524.66,"maximum":115775.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":76103.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":71221.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":76103.31},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67465.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62912.97},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58794.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28699.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28699.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21524.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115775.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5685.4,"maximum":28388.59,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18660.86},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17463.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18660.86},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16542.83},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15426.53},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14416.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7580.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7580.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5685.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28388.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7678.51,"maximum":39384.71,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25889.01},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24228.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25889.01},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22950.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21401.89},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20000.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10238.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10238.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7678.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39384.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7477.52,"maximum":38275.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25160.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23546.26},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25160.09},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22304.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20799.3},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19437.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9970.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9970.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38275.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4951.61,"maximum":24340.16,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15999.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14973.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15999.67},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14183.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13226.59},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12360.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6602.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6602.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4951.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24340.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6832.98,"maximum":34719.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22822.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21358.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22822.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20232.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18866.99},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17631.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9110.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9110.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6832.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34719.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20299.04,"maximum":109013.42,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":71658.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":67062.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":71658.5},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63525.17},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59238.54},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55360.16},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27065.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27065.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20299.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109013.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7853.68,"maximum":40351.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26524.27},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24822.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26524.27},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23513.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21927.05},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20491.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10471.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10471.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40351.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11305.39,"maximum":59394.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39042.22},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36537.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39042.22},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34610.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32275.36},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30162.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11305.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59394.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8785.66,"maximum":45492.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29904.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27986.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29904.2},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26510.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24721.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23102.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8785.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45492.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7506.7,"maximum":38436.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25265.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23645.35},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25265.96},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22398.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20886.83},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19519.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10008.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10008.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7506.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38436.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10239.78,"maximum":53515.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35177.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32921.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35177.7},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31184.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29080.65},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27176.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10239.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53515.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":22271.36,"maximum":119894.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":78811.32},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":73756.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":78811.32},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69866.14},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65151.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60886.11},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29695.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29695.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22271.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119894.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":17996.02,"maximum":96307.47,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":63306.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":59245.81},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":63306.42},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56121.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52334.05},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48907.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23994.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23994.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17996.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96307.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":242983.81,"maximum":1337587.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":879244.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":822848.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":879244.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":779449.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":726852.89},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":679265.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":323978.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":323978.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":242983.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1337587.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":32006.11,"maximum":173602.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":114115.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":106795.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":114115.26},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101163.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94336.63},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88160.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42674.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42674.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32006.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":173602.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7660.54,"maximum":39285.59,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25823.86},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24167.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25823.86},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22892.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21348.03},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19950.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7660.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39285.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":26340.29,"10th_percentile":26340.29,"90th_percentile":26340.29},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":23112.39,"maximum":124534.99,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81861.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":76610.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":81861.4},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72570.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67673.06},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63242.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30816.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30816.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23112.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124534.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12344.04,"maximum":65124.94,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42809.0},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40063.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42809.0},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37950.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35389.28},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33072.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16458.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12344.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65124.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":19668.54,"maximum":105534.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":69371.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":64922.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":69371.96},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61498.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57348.31},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53593.68},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26224.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26224.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19668.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105534.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":32103.8,"maximum":174141.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":114469.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":107127.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":114469.54},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101477.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94629.5},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88434.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42805.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42805.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32103.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174141.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5330.58,"maximum":26430.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17374.04},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16259.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17374.04},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15402.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14362.75},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13422.41},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7107.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7107.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5330.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26430.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6684.2,"maximum":33899.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22283.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20853.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22283.08},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19753.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18420.94},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17214.91},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8912.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8912.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6684.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33899.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":23966.34,"maximum":129246.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":84958.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":79508.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":84958.31},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75315.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70233.2},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65635.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31955.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31955.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129246.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15968.12,"maximum":85119.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55952.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52363.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55952.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49601.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46254.34},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43226.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21290.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21290.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15968.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85119.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7165.91,"maximum":36556.7,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24030.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22488.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24030.05},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21302.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19865.13},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18564.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9554.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9554.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7165.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36556.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18657.96,"maximum":99959.42,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65706.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61492.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65706.98},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58249.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54318.55},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50762.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24877.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24877.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18657.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99959.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":32284.82,"10th_percentile":32284.82,"90th_percentile":32284.82,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20895.84,"maximum":112306.06,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":73822.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":69087.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":73822.88},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65443.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61027.78},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57032.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27861.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27861.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20895.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112306.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16210.1,"maximum":86454.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56829.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":53184.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":56829.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50379.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46979.8},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43904.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21613.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21613.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16210.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86454.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9833.86,"maximum":51276.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33705.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31543.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33705.6},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29879.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27863.69},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26039.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13111.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13111.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9833.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51276.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8927.14,"maximum":46273.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30417.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28466.26},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30417.3},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26964.9},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25145.32},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23499.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8927.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46273.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4583.87,"maximum":22311.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14666.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13725.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14666.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13001.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12124.09},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11330.32},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6111.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4583.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22311.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7015.45,"maximum":35726.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23484.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21978.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23484.38},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20818.87},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19414.03},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18142.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7015.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35726.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5200.33,"maximum":25712.35,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16901.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15817.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16901.67},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14983.31},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13972.24},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13057.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6933.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6933.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5200.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25712.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8539.18,"maximum":44133.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29010.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27149.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29010.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25717.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23982.23},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22412.1},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11385.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11385.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8539.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44133.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":11668.44,"10th_percentile":11668.44,"90th_percentile":11668.44,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":37321.78,"maximum":202929.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":133393.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":124836.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":133393.06},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118252.77},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110273.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103053.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49762.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49762.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37321.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":202929.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8641.94,"maximum":44700.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29382.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27498.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29382.96},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26047.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24290.26},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22699.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44700.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12446.23,"maximum":65688.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43179.57},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40409.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43179.57},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38278.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35695.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33358.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16594.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16594.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12446.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65688.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5429.39,"maximum":26976.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17732.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16595.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17732.39},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15719.75},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14658.99},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13699.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7239.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7239.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5429.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26976.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":16783.64,"10th_percentile":13344.56,"90th_percentile":17933.97,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":16783.64,"10th_percentile":16783.64,"90th_percentile":16783.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3569.42,"10th_percentile":3569.42,"90th_percentile":3569.42,"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":7839.07,"10th_percentile":7022.78,"90th_percentile":8147.15,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7319.7,"10th_percentile":7319.7,"90th_percentile":7319.7,"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":6572.68,"10th_percentile":6572.68,"90th_percentile":6572.68,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4676.87,"10th_percentile":4676.87,"90th_percentile":4676.87,"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":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":8676.6,"10th_percentile":8676.6,"90th_percentile":8676.6,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11040.39,"maximum":57932.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38081.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35638.57},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38081.18},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33758.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31480.89},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29419.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14720.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11040.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57932.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":39329.31,"10th_percentile":39329.31,"90th_percentile":39329.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":15791.4,"10th_percentile":12596.47,"90th_percentile":17020.57,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":15357.79,"10th_percentile":15357.79,"90th_percentile":15357.79,"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9800.74,"maximum":51093.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33585.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31431.22},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33585.47},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29773.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27764.38},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25946.64},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13067.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13067.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9800.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51093.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":17295.0,"10th_percentile":17295.0,"90th_percentile":17295.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8826.08,"maximum":45716.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30050.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28123.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30050.8},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26640.0},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24842.35},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23215.91},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11768.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11768.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8826.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45716.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":2834.0,"10th_percentile":2834.0,"90th_percentile":2834.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent 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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":4607.74,"10th_percentile":4607.74,"90th_percentile":4607.74,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4079.14,"maximum":19526.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12835.57},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12012.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12835.57},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11378.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10610.89},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9916.19},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5438.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5438.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4079.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19526.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4364.91,"maximum":21103.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13871.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12982.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13871.95},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12297.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11467.64},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10716.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5819.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5819.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4364.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21103.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6155.33,"maximum":30981.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20365.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19058.81},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20365.07},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18053.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16835.37},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15733.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8207.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8207.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6155.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30981.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9985.45,"maximum":52112.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34255.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32058.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34255.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30367.32},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28318.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26464.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13313.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13313.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52112.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7199.6,"maximum":36742.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24152.22},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22603.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24152.22},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21410.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19966.12},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18658.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9599.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7199.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36742.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20867.77,"maximum":112151.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":73721.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":68992.44},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":73721.07},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65353.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60943.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56953.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27823.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27823.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20867.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112151.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18230.71,"maximum":97602.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64157.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":60042.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64157.51},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56875.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53037.63},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49565.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24307.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24307.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18230.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97602.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4369.4,"maximum":21128.05,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13888.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12997.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13888.24},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12311.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11481.11},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10729.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5825.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5825.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4369.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21128.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7299.54,"maximum":37293.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24514.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22942.22},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24514.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21732.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20265.73},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18938.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9732.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9732.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37293.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":10849.17,"10th_percentile":10849.17,"90th_percentile":10863.17,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":35430.04,"10th_percentile":35430.04,"90th_percentile":35430.04},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6533.18,"maximum":33065.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21735.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20341.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21735.37},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19268.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17968.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16791.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6533.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33065.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":33065.81,"10th_percentile":33065.81,"90th_percentile":33065.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5759.52,"maximum":28797.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18929.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17715.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18929.62},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16781.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15648.71},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14624.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5759.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28797.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4599.59,"maximum":22398.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14723.04},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13778.67},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14723.04},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13051.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12171.22},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11374.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6132.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6132.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4599.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22398.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":19020.64,"maximum":101960.41,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":67022.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":62723.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":67022.3},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59415.19},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55405.89},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51778.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25360.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25360.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19020.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101960.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":34946.91,"maximum":189827.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":124780.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":116776.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":124780.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110617.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103153.23},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96399.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46595.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46595.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34946.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":189827.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18180.74,"maximum":97326.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":63976.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":59872.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":63976.3},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56714.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52887.83},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49425.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24240.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24240.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18180.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97326.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12793.19,"maximum":67602.94,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44437.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41587.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44437.88},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39394.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36735.84},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34330.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17057.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17057.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12793.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67602.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":24057.29,"maximum":129748.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":85288.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":79817.58},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":85288.16},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75607.84},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70505.88},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65889.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32076.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32076.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24057.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129748.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":28837.36,"maximum":156120.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":102623.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":96041.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":102623.51},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90975.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84836.65},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79282.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38449.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28837.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":156120.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":61591.0,"maximum":336825.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":221407.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":207205.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":221407.55},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":196277.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":183032.85},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":171049.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82121.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82121.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61591.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":336825.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5992.52,"maximum":30082.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19774.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18506.22},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19774.6},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17530.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16347.24},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15276.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7990.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7990.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5992.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30082.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":16382.14,"10th_percentile":16382.14,"90th_percentile":16382.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5064.46,"maximum":24962.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16408.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15356.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16408.93},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14546.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13564.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12676.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6752.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6752.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5064.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24962.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":5509.57,"10th_percentile":5509.57,"90th_percentile":5509.57,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":14095.69,"10th_percentile":14095.69,"90th_percentile":14095.69},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":16765.88,"10th_percentile":16765.88,"90th_percentile":16765.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9289.83,"maximum":48274.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31732.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29697.22},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31732.62},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28130.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26232.67},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24515.21},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12386.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12386.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9289.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48274.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6019.46,"maximum":30231.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19872.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18597.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19872.34},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17616.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16428.03},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15352.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8025.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8025.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6019.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30231.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":17541.45,"10th_percentile":17541.45,"90th_percentile":17541.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11286.86,"maximum":59292.35,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38975.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36475.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38975.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34551.31},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32219.81},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30110.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15049.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15049.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11286.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59292.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9317.9,"maximum":48429.41,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31834.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29792.49},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31834.42},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28221.18},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26316.83},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24593.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48429.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12427.7,"maximum":65586.47,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43112.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40347.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43112.38},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38219.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35640.08},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33306.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16570.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16570.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12427.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65586.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5515.29,"maximum":27450.05,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18043.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16886.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18043.92},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15995.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14916.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13939.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5515.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27450.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7071.03,"maximum":36033.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23685.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22166.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23685.95},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20997.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19580.67},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18298.71},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9428.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9428.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7071.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36033.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5607.37,"maximum":27958.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18377.84},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17199.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18377.84},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16291.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15192.56},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14197.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7476.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7476.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27958.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5010.56,"maximum":24665.39,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16213.46},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15173.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16213.46},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14373.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13403.32},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12525.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24665.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13295.12,"maximum":70372.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46258.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43291.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46258.16},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41007.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38240.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35736.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17726.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17726.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13295.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70372.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6327.13,"maximum":31929.03,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20988.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19641.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20988.12},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18605.94},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17350.43},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16214.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8436.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8436.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6327.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31929.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":22908.03,"maximum":123407.5,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81120.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":75917.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":81120.26},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71913.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67060.37},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62669.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30544.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30544.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22908.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123407.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6415.84,"maximum":32418.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21309.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19942.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21309.82},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18891.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17616.37},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16463.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8554.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8554.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6415.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32418.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7048.01,"maximum":35906.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23602.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22088.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23602.47},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20923.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19511.65},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18234.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35906.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":26802.71,"maximum":144894.86,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":95244.69},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":89135.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":95244.69},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84434.29},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78736.73},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73581.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35736.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35736.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26802.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144894.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":31362.14,"maximum":170049.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":111779.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":104610.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":111779.85},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99092.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92406.0},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86356.13},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41816.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41816.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31362.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":170049.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6212.6,"maximum":31297.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20572.75},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19253.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20572.75},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18237.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17007.05},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15893.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8283.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8283.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6212.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31297.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":49157.43,"maximum":268228.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":176316.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":165006.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":176316.08},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":156303.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":145756.7},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":136213.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65543.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65543.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49157.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":268228.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6142.42,"maximum":30909.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20318.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19014.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20318.24},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18012.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16796.65},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15696.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8189.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8189.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6142.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30909.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11445.74,"maximum":60168.94,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39551.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37014.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39551.24},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35062.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32696.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30555.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15260.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15260.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11445.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60168.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":39868.14,"10th_percentile":39868.14,"90th_percentile":39950.32,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":21696.96,"10th_percentile":21696.96,"90th_percentile":23578.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":10792.27,"10th_percentile":7514.76,"90th_percentile":14687.86,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17987.78,"10th_percentile":17987.78,"90th_percentile":17987.78,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9178.09,"10th_percentile":9178.09,"90th_percentile":9178.09,"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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":44337.93,"10th_percentile":44337.93,"90th_percentile":44337.93},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":36108.37,"10th_percentile":36108.37,"90th_percentile":36108.37},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8381.98,"maximum":43265.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28440.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26616.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28440.24},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25212.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23510.94},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21971.66},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11175.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11175.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8381.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43265.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11288.54,"maximum":59301.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38981.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36480.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38981.13},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34556.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32224.86},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30115.09},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11288.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59301.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":38637.03,"10th_percentile":38637.03,"90th_percentile":38637.03,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9717.08,"maximum":50631.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33282.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31147.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33282.09},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29504.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27513.59},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25712.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9717.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50631.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4404.77,"maximum":21323.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14016.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13117.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14016.51},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12425.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11587.15},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10828.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5873.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5873.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4404.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21323.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12105.44,"maximum":63808.5,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41943.66},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39253.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41943.66},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37183.0},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34673.92},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32403.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16140.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16140.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12105.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63808.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":544.88,"10th_percentile":544.88,"90th_percentile":544.88,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7219.25,"maximum":36850.96,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24223.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22669.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24223.48},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21474.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20025.03},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18713.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9625.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9625.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7219.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36850.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15888.39,"maximum":84679.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55662.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52092.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55662.9},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49345.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46015.32},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43002.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21184.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21184.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15888.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84679.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7825.6,"maximum":40196.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26422.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24727.67},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26422.47},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23423.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21842.89},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20412.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10434.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10434.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40196.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12772.42,"maximum":67488.33,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44362.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41517.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44362.55},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39327.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36673.56},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34272.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17029.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17029.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12772.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67488.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9781.65,"maximum":50987.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33516.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31366.44},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33516.24},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29712.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27707.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25893.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13042.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13042.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9781.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50987.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":11155.48,"10th_percentile":11155.48,"90th_percentile":11155.48,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":49720.36,"10th_percentile":49720.36,"90th_percentile":49720.36,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12423.2,"maximum":65561.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43096.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40331.81},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43096.09},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38204.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35626.61},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33294.12},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16564.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16564.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65561.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9074.8,"maximum":47088.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30952.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28967.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30952.79},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27439.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25588.01},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23912.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12099.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12099.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9074.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47088.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10617.62,"maximum":55600.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36548.0},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34203.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36548.0},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32399.75},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30213.44},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28235.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14156.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14156.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10617.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55600.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10666.47,"maximum":55869.61,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36725.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34369.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36725.14},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32556.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30359.88},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28372.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14221.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14221.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10666.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55869.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4408.14,"maximum":21341.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14028.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13128.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14028.73},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12436.45},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11597.25},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10837.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5877.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5877.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4408.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21341.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8406.69,"maximum":43402.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28529.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26699.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28529.83},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25291.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23585.0},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22040.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11208.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11208.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8406.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43402.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8080.49,"maximum":41602.52,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27346.86},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25592.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27346.86},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24242.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22607.06},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21126.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10773.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10773.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41602.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6483.77,"maximum":32793.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21556.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20173.53},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21556.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19109.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17820.04},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16653.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8645.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8645.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6483.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32793.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10699.6,"maximum":56052.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36845.27},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34481.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36845.27},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32663.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30459.19},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28465.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14266.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14266.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56052.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8328.65,"maximum":42971.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28246.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26435.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28246.82},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25040.77},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23351.03},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21822.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11104.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11104.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8328.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42971.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4265.54,"maximum":20555.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13511.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12644.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13511.56},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11977.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11169.72},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10438.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5687.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5687.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4265.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20555.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4382.31,"maximum":21199.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13935.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13041.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13935.07},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12353.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11519.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10765.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5843.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5843.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4382.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21199.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":6047.54,"10th_percentile":6047.54,"90th_percentile":6047.54,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10137.6,"maximum":52951.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34807.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32574.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34807.13},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30856.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28774.3},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26890.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13516.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13516.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52951.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12884.14,"maximum":68104.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44767.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41896.23},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44767.73},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39686.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37008.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34585.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17178.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17178.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12884.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68104.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9875.97,"maximum":51508.33,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33858.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31686.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33858.31},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30015.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27989.93},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26157.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13167.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13167.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9875.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51508.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":26066.67,"maximum":140834.03,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":92575.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":86637.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":92575.36},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82067.94},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76530.05},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71519.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34755.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34755.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26066.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140834.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":31038.75,"maximum":168265.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":110607.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":103512.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":110607.06},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98053.02},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91436.47},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85450.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41385.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41385.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31038.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168265.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":73246.98,"maximum":401132.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":263679.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":246766.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":263679.02},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":233751.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":217977.77},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":203706.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97662.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97662.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73246.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":401132.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4916.8,"maximum":24148.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15873.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14855.28},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15873.44},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14071.78},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13122.23},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12263.11},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6555.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4916.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24148.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":15887.69,"10th_percentile":15887.69,"90th_percentile":15887.69,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4618.82,"10th_percentile":4618.82,"90th_percentile":4618.82,"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":7250.12,"10th_percentile":7250.12,"90th_percentile":7287.51,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":20400.27,"10th_percentile":20400.27,"90th_percentile":20400.27,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":31253.22,"maximum":169448.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":111384.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":104240.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":111384.85},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98742.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92079.46},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86050.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41670.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41670.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31253.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":169448.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9862.49,"maximum":51433.99,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33809.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31640.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33809.44},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29972.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27949.54},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26119.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13149.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9862.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51433.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10294.8,"maximum":53819.06,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35377.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33108.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35377.24},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31361.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29245.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27330.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13726.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13726.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10294.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53819.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":51123.02,"maximum":279072.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":183444.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":171677.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":183444.47},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":162623.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":151649.59},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":141721.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68164.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68164.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51123.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":279072.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9692.38,"maximum":50495.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33192.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31063.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33192.5},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29425.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27439.53},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25643.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12923.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12923.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9692.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50495.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":13011.9,"10th_percentile":13011.9,"90th_percentile":13011.9,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5184.61,"maximum":25625.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16844.66},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15764.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16844.66},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14932.77},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13925.11},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13013.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6912.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6912.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5184.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25625.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":31547.98,"maximum":171074.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":112453.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":105240.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":112453.8},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99690.15},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92963.14},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86876.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42063.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31547.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171074.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":17569.34,"maximum":93953.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61758.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":57797.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61758.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54749.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51054.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47712.24},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23425.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23425.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93953.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":19935.22,"maximum":107006.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":70339.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65827.4},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":70339.11},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62355.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58147.83},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54340.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26580.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26580.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19935.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107006.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12280.04,"maximum":64771.82,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42576.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39845.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42576.89},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37744.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35197.4},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32893.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12280.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64771.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":17468.49,"10th_percentile":17468.49,"90th_percentile":17468.49,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"1 through 10","median_amount":33012.59,"10th_percentile":33012.59,"90th_percentile":33012.59,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10667.6,"maximum":55875.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36729.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34373.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36729.21},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32560.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30363.24},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28375.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14223.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14223.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10667.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55875.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11034.21,"maximum":57898.47,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38058.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35617.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38058.78},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33739.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31462.37},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29402.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14712.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14712.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11034.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57898.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9378.53,"maximum":48763.94,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32054.32},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29998.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32054.32},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28416.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26498.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24763.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9378.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48763.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16654.19,"maximum":88904.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58440.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":54691.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":58440.14},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51807.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48311.21},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45148.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22205.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22205.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16654.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88904.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11598.46,"maximum":61011.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40105.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37532.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40105.06},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35553.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33153.99},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30983.38},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15464.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15464.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11598.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61011.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5234.57,"maximum":25901.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17025.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15933.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17025.87},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15093.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14074.92},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13153.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6979.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6979.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5234.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25901.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":6583.45,"10th_percentile":6583.45,"90th_percentile":6583.45,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7960.91,"maximum":40942.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26913.17},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25186.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26913.17},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23858.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22248.54},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20791.91},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7960.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40942.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5567.5,"maximum":27738.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18233.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17063.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18233.28},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16163.78},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15073.06},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14086.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7423.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5567.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27738.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20029.54,"maximum":107526.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":70681.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":66147.53},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":70681.18},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62658.77},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58430.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54605.12},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26706.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26706.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20029.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107526.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11356.48,"maximum":59676.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39227.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36711.36},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39227.5},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34775.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32428.53},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30305.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15141.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15141.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59676.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6617.39,"maximum":33530.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22040.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20627.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22040.78},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19539.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18220.64},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17027.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8823.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8823.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6617.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33530.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8804.74,"maximum":45598.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29973.43},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28050.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29973.43},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26571.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24778.39},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23156.13},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11739.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11739.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45598.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8502.7,"maximum":43931.84,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28878.01},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27025.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28878.01},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25600.32},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23872.83},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22309.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11336.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11336.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8502.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43931.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6809.96,"maximum":34592.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22739.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21280.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22739.16},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20158.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18797.98},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17567.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9079.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9079.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6809.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34592.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":17295.0,"10th_percentile":17295.0,"90th_percentile":17295.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":1661.6,"maximum":6188.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":4068.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":3807.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":4068.13},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":3606.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":3363.03},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":3142.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2215.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2215.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1661.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6188.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":2834.0,"10th_percentile":2834.0,"90th_percentile":2834.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent 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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":2486.0,"10th_percentile":2486.0,"90th_percentile":2486.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1496.39,"10th_percentile":1496.39,"90th_percentile":2152.05,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1461.87,"10th_percentile":1461.87,"90th_percentile":1461.87,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":4099.8,"10th_percentile":3714.22,"90th_percentile":4350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10976.38,"maximum":57579.43,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37849.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35421.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37849.06},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33553.15},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31289.0},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29240.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14635.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14635.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10976.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57579.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8424.1,"maximum":43498.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28592.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26758.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28592.95},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25347.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23637.18},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22089.64},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11232.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11232.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43498.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5367.64,"maximum":26635.4,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17508.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16385.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17508.42},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15521.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14473.84},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13526.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5367.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26635.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13515.76,"maximum":71589.42,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47058.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44039.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47058.34},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41717.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38902.12},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36355.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18021.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18021.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13515.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71589.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12250.28,"maximum":64607.66,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42468.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39744.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42468.97},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37648.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35108.19},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32809.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16333.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16333.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12250.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64607.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11739.38,"maximum":61788.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40616.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38010.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40616.12},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36006.14},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33576.47},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31378.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15652.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15652.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11739.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61788.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":28266.94,"maximum":152973.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":100554.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":94105.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":100554.83},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89141.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83126.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77684.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37689.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37689.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28266.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152973.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"1 through 10","median_amount":90014.06,"10th_percentile":90014.06,"90th_percentile":90014.06,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5523.71,"maximum":27496.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18074.46},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16915.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18074.46},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16022.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14941.77},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13963.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7364.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5523.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27496.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6285.02,"maximum":31696.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20835.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19498.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20835.41},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18470.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17224.19},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16096.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8380.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8380.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6285.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31696.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":17069.35,"10th_percentile":17069.35,"90th_percentile":17069.35,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":8672.05,"10th_percentile":8672.05,"90th_percentile":8672.05,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9178.09,"10th_percentile":9178.09,"90th_percentile":9178.09,"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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":31492.08,"10th_percentile":31492.08,"90th_percentile":31492.08},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"1 through 10","median_amount":15554.3,"10th_percentile":15554.3,"90th_percentile":15554.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12191.33,"maximum":64282.42,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42255.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39544.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42255.18},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37459.17},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34931.45},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32644.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16255.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16255.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12191.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64282.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7106.4,"maximum":36228.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23814.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22286.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23814.23},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21111.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19686.71},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18397.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9475.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9475.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7106.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36228.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":18115.46,"10th_percentile":18115.46,"90th_percentile":18115.46,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5511.36,"maximum":27428.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18029.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16873.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18029.67},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15983.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14904.74},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13928.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7348.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7348.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5511.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27428.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10361.61,"maximum":54187.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35619.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33334.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35619.53},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31576.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29445.9},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27518.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10361.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54187.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20911.56,"maximum":112392.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":73879.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":69141.07},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":73879.89},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65494.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61074.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57076.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27882.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27882.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20911.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112392.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4063.98,"maximum":19443.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12780.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11960.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12780.6},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11329.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10565.45},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9873.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5418.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5418.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4063.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19443.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9144.42,"maximum":47472.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31205.27},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29203.69},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31205.27},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27663.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25796.72},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24107.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12192.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9144.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47472.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":26881.31,"maximum":145328.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":95529.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":89402.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":95529.74},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84686.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78972.38},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73802.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35841.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35841.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26881.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145328.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20522.49,"maximum":110246.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72468.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":67820.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72468.87},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64243.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59908.45},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55986.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27363.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27363.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110246.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8734.0,"maximum":45208.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29716.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27810.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29716.88},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26343.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24566.3},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22957.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11645.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11645.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45208.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6294.56,"maximum":31749.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20870.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19531.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20870.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18501.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17252.8},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16123.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6294.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31749.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":7779.06,"10th_percentile":7779.06,"90th_percentile":7779.06,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18414.86,"maximum":98618.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64825.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":60667.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64825.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57467.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53589.72},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50081.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24553.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24553.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18414.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98618.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6417.52,"maximum":32427.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21315.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19948.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21315.93},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18896.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17621.42},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16467.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8556.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8556.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6417.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32427.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6600.55,"maximum":33437.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21979.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20569.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21979.7},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19484.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18170.14},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16980.54},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8800.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8800.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6600.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33437.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6422.57,"maximum":32455.61,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21334.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19965.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21334.26},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18912.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17636.57},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16481.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8563.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6422.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32455.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6591.01,"maximum":33384.86,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21945.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20537.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21945.09},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19454.29},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18141.53},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16953.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6591.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33384.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12239.06,"maximum":64545.71,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42428.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39706.81},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42428.25},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37612.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35074.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32778.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16318.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16318.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12239.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64545.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10700.16,"maximum":56055.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36847.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34483.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36847.3},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32665.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30460.87},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28466.58},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14266.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14266.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10700.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56055.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4312.7,"maximum":20815.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13682.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12804.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13682.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12129.6},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11311.1},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10570.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5750.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5750.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4312.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20815.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8546.49,"maximum":44173.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29036.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27174.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29036.82},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25741.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24004.12},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22432.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11395.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11395.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8546.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44173.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14955.28,"maximum":79531.41,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52278.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48925.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52278.9},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46345.18},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43217.84},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40388.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19940.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19940.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14955.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79531.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6196.31,"maximum":31207.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20513.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19197.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20513.71},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18185.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16958.24},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15847.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8261.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8261.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6196.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31207.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12547.28,"maximum":66246.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43546.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40752.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43546.07},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38603.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35998.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33641.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12547.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66246.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5034.7,"maximum":24798.59,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16301.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15255.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16301.02},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14450.83},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13475.7},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12593.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6712.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6712.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5034.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24798.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":3594.06,"maximum":16850.4,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11076.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10365.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11076.38},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9819.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9156.61},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8557.12},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4792.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4792.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3594.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16850.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":3701.56,"10th_percentile":3701.56,"90th_percentile":3701.56,"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":13766.6,"10th_percentile":13766.6,"90th_percentile":13766.6,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":19845.4,"maximum":106510.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":70013.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65522.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":70013.33},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62066.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57878.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54089.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26460.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26460.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19845.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106510.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9098.94,"maximum":47221.39,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31040.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29049.35},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31040.34},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27517.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25660.38},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23980.39},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12131.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12131.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47221.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":11776.63,"10th_percentile":11776.63,"90th_percentile":11776.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9157.89,"maximum":47546.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31254.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29249.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31254.14},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27706.75},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25837.12},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24145.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12210.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12210.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9157.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47546.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":26346.27,"maximum":142376.59,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":93589.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":87586.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":93589.34},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82966.83},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77368.29},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72302.95},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35128.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35128.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26346.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142376.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15815.41,"maximum":84276.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55398.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51844.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55398.21},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49110.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45796.51},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42798.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21087.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21087.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84276.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4582.18,"maximum":22302.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14659.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13719.6},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14659.92},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12996.0},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12119.04},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11325.6},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6109.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6109.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4582.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22302.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4779.25,"maximum":23389.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15374.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14388.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15374.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13629.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12709.84},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11877.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6372.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6372.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4779.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23389.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4099.35,"maximum":19638.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12908.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12080.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12908.87},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11443.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10671.49},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9972.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5465.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5465.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4099.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19638.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6547.77,"maximum":33146.35,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21788.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20390.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21788.31},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19315.31},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18011.92},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16832.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6547.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33146.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20787.49,"maximum":111708.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":73429.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":68719.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":73429.91},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65095.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60702.92},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56728.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27716.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27716.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20787.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111708.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20506.21,"maximum":110156.39,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72409.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":67765.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72409.82},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64191.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59859.64},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55940.6},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27341.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27341.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20506.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110156.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":17705.2,"maximum":94702.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62251.72},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":58258.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":62251.72},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55186.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51462.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48092.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23606.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23606.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17705.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94702.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15684.03,"maximum":83551.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54921.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51398.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":54921.76},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48688.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45402.64},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42430.1},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20912.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20912.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15684.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83551.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12503.49,"maximum":66004.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43387.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40604.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43387.25},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38462.75},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35867.31},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33519.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16671.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16671.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12503.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66004.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":43462.78,"maximum":236810.07,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":155663.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":145679.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":155663.92},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":137995.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":128684.01},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120259.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57950.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57950.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43462.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":236810.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":37455.97,"maximum":203669.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":133879.68},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":125292.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":133879.68},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118684.17},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110675.45},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103429.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49941.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49941.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37455.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203669.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":36666.59,"maximum":199314.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":131016.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":122613.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":131016.93},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":116146.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":108308.87},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101217.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48888.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48888.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36666.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":199314.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10444.14,"maximum":54643.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35918.84},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33614.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35918.84},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31842.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29693.33},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27749.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13925.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13925.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54643.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5272.76,"maximum":26111.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17164.32},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16063.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17164.32},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15216.15},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14189.38},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13260.39},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7030.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5272.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26111.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":16370.15,"10th_percentile":16370.15,"90th_percentile":16370.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4939.59,"10th_percentile":4939.59,"90th_percentile":4939.59,"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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9129.26,"maximum":47388.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31150.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29152.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31150.29},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27614.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25751.28},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24065.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12172.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12172.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9129.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47388.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8251.73,"maximum":42547.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27967.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26173.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27967.87},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24793.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23120.44},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21606.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11002.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11002.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8251.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42547.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":10823.29,"10th_percentile":10823.29,"90th_percentile":10823.29,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8758.33,"10th_percentile":8758.33,"90th_percentile":8758.33,"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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4517.62,"maximum":21945.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14425.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13500.47},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14425.77},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12788.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11925.47},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11144.71},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6023.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6023.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4517.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21945.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4660.78,"maximum":22735.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14944.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13986.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14944.97},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13248.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12354.69},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11545.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6214.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6214.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4660.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22735.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":21574.62,"maximum":116050.94,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":76284.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":71391.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":76284.52},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67626.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63062.77},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58934.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28766.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28766.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21574.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116050.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12723.02,"maximum":67215.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44183.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41349.35},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44183.37},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39168.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36525.44},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34134.1},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16964.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16964.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12723.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67215.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9157.33,"maximum":47543.53,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31252.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29247.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31252.1},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27704.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25835.44},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24143.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9157.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47543.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13424.25,"maximum":71084.53,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46726.46},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43729.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46726.46},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41422.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38627.76},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36098.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17899.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17899.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13424.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71084.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5161.59,"maximum":25498.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16761.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15686.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16761.18},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14858.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13856.1},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12948.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5161.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25498.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13372.04,"maximum":70796.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46537.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43552.11},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46537.1},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41255.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38471.22},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35952.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13372.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70796.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6300.18,"maximum":31780.35,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20890.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19550.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20890.39},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18519.3},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17269.63},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16138.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8400.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8400.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6300.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31780.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":7953.01,"10th_percentile":7953.01,"90th_percentile":7953.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6966.61,"maximum":35457.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23307.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21812.26},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23307.24},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20661.84},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19267.59},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18006.13},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6966.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35457.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7257.99,"maximum":37064.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24363.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22801.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24363.97},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21598.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20141.17},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18822.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9677.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9677.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7257.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37064.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5306.44,"maximum":26297.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17286.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16177.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17286.49},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15324.45},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14290.37},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13354.77},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7075.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7075.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26297.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4426.1,"maximum":21440.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14093.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13189.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14093.88},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12494.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11651.11},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10888.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5901.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5901.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4426.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21440.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":34263.08,"maximum":186054.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":122300.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":114455.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":122300.38},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":108419.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101103.09},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94483.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45684.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45684.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34263.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186054.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":39154.88,"maximum":213042.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":140040.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":131058.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":140040.92},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":124146.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115768.81},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":108189.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52206.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52206.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39154.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":213042.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18802.24,"maximum":100755.48,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":66230.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61982.1},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":66230.26},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58713.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54751.13},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51166.54},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25069.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25069.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18802.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100755.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20124.43,"maximum":108050.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":71025.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":66469.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":71025.28},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62963.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58715.07},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54870.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26832.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26832.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20124.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108050.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16543.59,"maximum":88294.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58039.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":54316.28},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":58039.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51451.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47979.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44838.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22058.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22058.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16543.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88294.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18222.28,"maximum":97555.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64126.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":60013.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64126.97},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56848.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53012.38},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49541.64},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24296.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24296.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18222.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97555.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":56442.07,"maximum":308418.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":202734.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":189730.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":202734.48},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":179723.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":167596.22},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":156623.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75256.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75256.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56442.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":308418.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5072.88,"maximum":25009.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16439.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15385.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16439.47},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14573.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13590.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12700.4},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6763.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6763.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5072.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25009.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11135.27,"maximum":58456.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38425.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35960.6},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38425.28},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34063.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31765.35},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29685.66},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58456.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":16618.2,"10th_percentile":16618.2,"90th_percentile":16618.2,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4566.46,"maximum":22215.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14602.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13666.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14602.91},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12945.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12071.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11281.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6088.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6088.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4566.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22215.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10454.81,"maximum":54701.85,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35957.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33651.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35957.53},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31876.3},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29725.31},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27779.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13939.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13939.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10454.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54701.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10664.79,"maximum":55860.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36719.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34363.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36719.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32551.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30354.83},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28367.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10664.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55860.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4419.93,"maximum":21406.82,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14071.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13168.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14071.49},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12474.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11632.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10871.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5893.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5893.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4419.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21406.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5015.06,"maximum":24690.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16229.75},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15188.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16229.75},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14387.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13416.79},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12538.38},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6686.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6686.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5015.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24690.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":24486.79,"maximum":132117.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":86845.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":81275.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":86845.77},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76988.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71793.53},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67093.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32649.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32649.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132117.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5023.47,"maximum":24736.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16260.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15217.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16260.29},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14414.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13442.04},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12561.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6697.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6697.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5023.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24736.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5235.14,"maximum":25904.39,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17027.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15935.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17027.9},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15095.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14076.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13155.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6980.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6980.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5235.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25904.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15020.41,"maximum":79890.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52515.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49146.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52515.09},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46554.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43413.09},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40570.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15020.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79890.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5675.3,"maximum":28332.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18624.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17429.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18624.21},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16510.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15396.23},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14388.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7567.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7567.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5675.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28332.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8421.28,"maximum":43482.71,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28582.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26749.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28582.77},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25338.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23628.76},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22081.77},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8421.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43482.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6264.25,"maximum":31582.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20760.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19428.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20760.08},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18403.78},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17161.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16038.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8352.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8352.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6264.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31582.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9649.71,"maximum":50260.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33037.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30918.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33037.76},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29287.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27311.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25523.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12866.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12866.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9649.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50260.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12864.5,"maximum":67996.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44696.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41829.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44696.47},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39623.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36949.61},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34530.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17152.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17152.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12864.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67996.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18378.92,"maximum":98419.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64695.04},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":60545.36},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64695.04},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57352.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53482.0},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49980.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24505.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24505.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18378.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98419.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16719.32,"maximum":89263.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58676.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":54912.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":58676.33},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52016.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48506.46},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45330.71},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22292.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22292.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16719.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89263.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":78306.64,"maximum":429047.12,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":282028.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":263938.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":282028.36},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":250017.77},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":233146.76},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":217882.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104408.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104408.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78306.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":429047.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4183.57,"maximum":20102.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13214.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12366.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13214.29},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11714.45},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10923.97},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10208.77},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4183.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20102.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20558.42,"maximum":110444.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72599.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":67942.51},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72599.18},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64359.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60016.18},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56086.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27411.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27411.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20558.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110444.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8193.91,"maximum":42228.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27758.15},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25977.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27758.15},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24607.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22947.07},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21444.71},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10925.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10925.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42228.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12823.51,"maximum":67770.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44547.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41690.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44547.83},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39491.6},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36826.73},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34415.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17098.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17098.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12823.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67770.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6469.73,"maximum":32715.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21505.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20125.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21505.29},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19064.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17777.96},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16614.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8626.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8626.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6469.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32715.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10615.94,"maximum":55590.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36541.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34198.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36541.89},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32394.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30208.39},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28230.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14154.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14154.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55590.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":30462.16,"maximum":165084.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":108515.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":101555.53},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":108515.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96199.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89707.83},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83834.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40616.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40616.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30462.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":165084.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18026.9,"maximum":96477.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":63418.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":59350.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":63418.41},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56220.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52426.63},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48994.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96477.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":17080.32,"maximum":91255.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59985.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":56137.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":59985.54},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53177.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49588.76},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46342.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22773.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22773.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17080.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91255.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16890.56,"maximum":90208.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59297.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":55493.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":59297.34},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52567.02},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49019.83},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45810.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22520.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22520.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16890.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90208.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6809.96,"maximum":34592.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22739.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21280.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22739.16},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20158.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18797.98},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17567.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9079.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9079.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6809.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34592.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11851.66,"maximum":62408.43,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41023.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38392.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41023.34},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36367.14},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33913.11},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31692.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15802.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15802.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62408.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10681.63,"maximum":55953.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36780.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34420.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36780.11},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32605.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30405.32},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28414.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14242.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14242.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55953.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12207.05,"maximum":64369.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42312.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39598.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42312.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37509.71},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34978.58},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32688.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16276.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16276.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12207.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64369.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5065.58,"maximum":24968.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16413.0},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15360.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16413.0},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14550.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13568.28},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12679.95},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5065.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24968.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10457.62,"maximum":54717.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35967.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33660.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35967.71},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31885.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29733.73},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27787.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13943.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10457.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54717.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5447.36,"maximum":27075.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17797.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16655.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17797.55},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15777.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14712.85},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13749.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5447.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27075.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5554.59,"maximum":27666.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18186.45},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17019.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18186.45},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16122.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15034.34},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14050.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5554.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27666.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":15406.43,"10th_percentile":15406.43,"90th_percentile":15406.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4746.68,"maximum":23209.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15256.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14277.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15256.5},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13524.87},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12612.22},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11786.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4746.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23209.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15421.84,"maximum":82105.43,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53970.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":50509.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53970.9},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47845.14},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44616.58},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41695.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20562.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20562.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15421.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82105.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11370.51,"maximum":59753.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39278.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36759.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39278.41},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34820.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32470.61},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30344.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15160.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15160.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59753.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4859.54,"maximum":23832.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15665.75},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14660.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15665.75},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13887.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12950.54},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12102.66},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6479.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6479.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4859.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23832.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5628.7,"maximum":28075.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18455.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17271.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18455.21},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16360.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15256.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14257.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7504.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5628.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28075.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9008.55,"maximum":46722.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30712.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28742.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30712.53},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27226.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25389.39},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23727.13},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12011.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12011.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9008.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46722.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":33908.81,"maximum":184099.91,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":121015.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":113253.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":121015.6},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107280.18},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100040.99},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93491.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45211.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45211.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33908.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":184099.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5172.82,"maximum":25560.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16801.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15724.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16801.9},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14894.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13889.77},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12980.4},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5172.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25560.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5392.9,"maximum":26774.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17600.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16471.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17600.05},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15602.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14549.58},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13597.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7190.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7190.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5392.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26774.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5703.94,"maximum":28490.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18728.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17526.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18728.05},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16602.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15482.07},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14468.45},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7605.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7605.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5703.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28490.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10709.14,"maximum":56105.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36879.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34514.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36879.88},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32693.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30487.8},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28491.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14278.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14278.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10709.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56105.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13960.98,"maximum":74045.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48672.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":45550.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48672.97},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43148.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40236.9},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37602.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18614.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18614.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13960.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74045.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14704.32,"maximum":78146.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51368.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48073.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51368.77},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45538.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42465.45},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39685.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19605.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19605.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14704.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78146.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":40596.08,"maximum":220994.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":145267.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":135949.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":145267.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":128779.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120089.59},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112227.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54128.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54128.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40596.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":220994.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":40826.84,"maximum":222267.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":146104.43},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":136732.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":146104.43},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":129521.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120781.38},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112873.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54435.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54435.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40826.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":222267.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":157876.22,"maximum":868040.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":570594.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":533995.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":570594.63},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":505831.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":471698.28},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":440815.95},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210501.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210501.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157876.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":868040.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":19085.78,"maximum":102319.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":67258.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":62944.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":67258.49},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59624.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55601.15},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51960.91},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25447.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25447.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19085.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102319.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8207.94,"maximum":42305.66,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27809.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26025.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27809.05},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24652.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22989.15},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21484.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8207.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42305.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":26827.65,"10th_percentile":26827.65,"90th_percentile":26827.65,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":41067.69,"maximum":223596.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":146977.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":137550.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":146977.91},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":130295.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":121503.48},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":113548.58},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54756.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54756.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41067.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":223596.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13998.59,"maximum":74253.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48809.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":45678.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48809.39},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43269.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40349.67},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37707.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18664.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18664.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13998.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74253.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":62636.88,"10th_percentile":62636.88,"90th_percentile":62636.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10437.97,"maximum":54608.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35896.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33593.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35896.44},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31822.15},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29674.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27731.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10437.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54608.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12246.92,"maximum":64589.07,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42456.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39733.49},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42456.76},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37637.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35098.09},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32800.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16329.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16329.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12246.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64589.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":15903.26,"10th_percentile":15903.26,"90th_percentile":15903.26,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9386.96,"maximum":48810.41,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32084.86},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30026.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32084.86},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28443.19},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26523.87},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24787.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9386.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48810.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5913.35,"maximum":29646.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19487.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18237.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19487.51},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17275.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16109.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15055.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5913.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29646.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4773.08,"maximum":23355.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15352.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14367.47},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15352.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13609.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12691.33},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11860.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6364.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4773.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23355.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4164.08,"10th_percentile":4164.08,"90th_percentile":4164.08,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2921.93,"10th_percentile":2921.93,"90th_percentile":2921.93,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12479.91,"maximum":65874.53,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43301.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40524.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43301.74},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38386.94},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35796.61},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33452.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16639.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16639.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12479.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65874.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7299.54,"maximum":37293.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24514.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22942.22},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24514.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21732.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20265.73},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18938.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9732.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9732.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37293.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8989.46,"maximum":46617.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30643.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28677.78},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30643.31},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27165.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25332.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23673.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11985.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11985.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8989.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46617.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12259.27,"maximum":64657.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42501.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39775.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42501.55},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37677.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35135.12},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32834.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16345.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16345.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12259.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64657.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15095.08,"maximum":80302.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52785.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49400.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52785.89},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46794.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43636.96},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40780.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20126.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20126.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15095.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80302.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":26077.9,"maximum":140895.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":92616.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":86675.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":92616.08},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82104.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76563.72},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71551.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34770.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34770.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26077.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140895.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12291.83,"maximum":64836.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42619.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39885.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42619.65},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37782.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35232.74},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32926.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16389.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16389.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12291.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64836.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5822.4,"maximum":29144.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19157.66},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17928.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19157.66},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16983.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15837.23},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14800.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7763.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7763.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5822.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29144.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8487.54,"maximum":43848.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28823.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26974.26},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28823.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25551.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23827.38},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22267.39},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11316.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11316.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8487.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43848.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11568.14,"maximum":60844.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39995.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37429.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39995.11},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35455.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33063.1},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30898.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15424.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15424.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11568.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60844.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9345.41,"maximum":48581.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31934.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29885.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31934.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28309.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26399.31},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24670.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12460.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12460.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9345.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48581.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6790.54,"10th_percentile":6790.54,"90th_percentile":6790.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6463.07,"10th_percentile":6463.07,"90th_percentile":6463.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":20359.31,"10th_percentile":20359.31,"90th_percentile":20359.31},{"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":40809.99,"maximum":222174.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":146043.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":136675.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":146043.34},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":129467.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120730.89},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112826.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54413.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54413.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40809.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":222174.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9234.25,"maximum":47967.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31531.04},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29508.57},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31531.04},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27952.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26066.04},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24359.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9234.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47967.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":21666.7,"maximum":116558.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":76618.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":71703.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":76618.44},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67922.15},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63338.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59191.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28888.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28888.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21666.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116558.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15347.17,"maximum":81693.47,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53700.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":50255.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53700.1},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47605.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44392.72},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41486.3},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20462.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20462.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15347.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81693.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":19788.13,"maximum":106194.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":69805.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65328.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":69805.65},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61882.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57706.83},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53928.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26384.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26384.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19788.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106194.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":17495.78,"maximum":93547.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61492.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":57548.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61492.26},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54512.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50834.32},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47506.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23327.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23327.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17495.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93547.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4027.48,"maximum":19241.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12648.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11836.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12648.25},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11212.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10456.04},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9771.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5369.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5369.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4027.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19241.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":12648.25,"10th_percentile":12648.25,"90th_percentile":12648.25,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":11939.86,"10th_percentile":11939.86,"90th_percentile":11939.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":21345.56,"maximum":114787.16,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":75453.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":70614.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":75453.79},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66889.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62376.03},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58292.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28460.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28460.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21345.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114787.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14805.38,"maximum":78704.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51735.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48416.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51735.26},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45863.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42768.43},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39968.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19740.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19740.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14805.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78704.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6750.45,"maximum":34264.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22523.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21078.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22523.34},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19966.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18619.56},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17400.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9000.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9000.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34264.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9755.26,"maximum":50842.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33420.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31276.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33420.55},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29627.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27628.04},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25819.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13007.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13007.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9755.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50842.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5084.67,"maximum":25074.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16482.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15425.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16482.23},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14611.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13625.5},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12733.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6779.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5084.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25074.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":7442.84,"10th_percentile":7442.84,"90th_percentile":7442.84,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":7420.0,"10th_percentile":7420.0,"90th_percentile":7420.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4413.2,"maximum":21369.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14047.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13146.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14047.05},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12452.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11612.4},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10852.13},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5884.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5884.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4413.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21369.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6476.47,"maximum":32752.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21529.72},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20148.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21529.72},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19086.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17798.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16632.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8635.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8635.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6476.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32752.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7109.78,"maximum":36246.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23826.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22298.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23826.44},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21122.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19696.81},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18407.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7109.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36246.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20608.39,"maximum":110720.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72780.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":68112.1},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72780.39},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64519.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60165.98},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56226.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27477.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27477.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20608.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110720.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12044.24,"maximum":63470.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41721.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39045.6},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41721.73},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36986.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34490.45},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32232.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12044.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63470.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6647.14,"maximum":33694.61,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22148.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20728.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22148.7},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19634.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18309.85},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17111.09},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8862.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8862.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33694.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10027.0,"maximum":52341.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34406.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32199.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34406.02},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30500.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28442.71},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26580.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13369.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13369.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10027.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52341.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8524.03,"maximum":44049.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28955.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27098.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28955.38},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25668.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23936.79},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22369.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11365.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11365.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8524.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44049.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16256.13,"maximum":86708.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56996.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":53340.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":56996.55},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50527.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47117.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44032.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21674.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21674.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86708.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":17728.22,"maximum":94829.96,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62335.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":58336.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":62335.2},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55260.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51531.17},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48157.4},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23637.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23637.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94829.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6026.76,"maximum":30271.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19898.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18622.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19898.81},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17640.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16449.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15372.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8035.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8035.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30271.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":3910.15,"maximum":18594.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12222.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11438.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12222.71},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10835.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10104.25},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9442.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5213.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5213.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3910.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18594.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6961.55,"maximum":35429.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23288.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21795.11},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23288.91},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20645.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19252.44},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17991.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9282.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9282.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6961.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35429.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13605.03,"maximum":72081.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47382.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44342.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47382.08},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42004.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39169.75},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36605.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18140.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18140.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13605.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72081.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11153.8,"maximum":58558.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38492.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36023.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38492.47},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34123.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31820.9},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29737.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14871.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14871.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11153.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58558.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5094.22,"maximum":25126.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16516.84},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15457.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16516.84},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14642.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13654.12},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12760.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6792.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6792.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5094.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25126.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20654.98,"maximum":110977.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72949.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":68270.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72949.39},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64669.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60305.69},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56357.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27539.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27539.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20654.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110977.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6568.54,"maximum":33260.96,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21863.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20461.26},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21863.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19382.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18074.2},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16890.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6568.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33260.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10337.47,"maximum":54054.47,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35531.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33252.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35531.98},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31499.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29373.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27450.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13783.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13783.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10337.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54054.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":17666.2,"10th_percentile":17666.2,"90th_percentile":17666.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5169.52,"10th_percentile":5169.52,"90th_percentile":5169.52,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7515.44,"10th_percentile":7515.44,"90th_percentile":7515.44,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":26591.92,"10th_percentile":26591.92,"90th_percentile":26591.92},{"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":22095.07,"maximum":118922.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":78171.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":73157.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":78171.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69299.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64623.1},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60392.19},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29460.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29460.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22095.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118922.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5351.92,"maximum":26548.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17451.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16332.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17451.41},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15470.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14426.71},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13482.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7135.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7135.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5351.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26548.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3908.8,"10th_percentile":3908.8,"90th_percentile":3908.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18622.59,"maximum":99764.28,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65578.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61372.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65578.71},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58135.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54212.51},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50663.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24830.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24830.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18622.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99764.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6978.4,"maximum":35522.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23349.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21852.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23349.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20699.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19302.94},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18039.16},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6978.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35522.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":43320.74,"maximum":236026.4,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":155148.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":145197.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":155148.78},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":137539.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":128258.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":119861.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57760.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57760.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43320.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":236026.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16742.9,"maximum":89393.85,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58761.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":54992.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":58761.85},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52092.3},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48577.15},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45396.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22323.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22323.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16742.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89393.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9767.61,"maximum":50910.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33465.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31318.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33465.34},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29666.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27665.08},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25853.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13023.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13023.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50910.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7330.98,"maximum":37467.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24628.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23048.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24628.67},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21833.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20359.99},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19027.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9774.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7330.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37467.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8291.6,"maximum":42767.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28112.43},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26309.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28112.43},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24921.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23239.94},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21718.41},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11055.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8291.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42767.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4623.73,"maximum":22531.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14810.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13860.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14810.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13129.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12243.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11442.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6164.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4623.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22531.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8388.16,"maximum":43299.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28462.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26636.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28462.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25232.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23529.45},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21988.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11184.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11184.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8388.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43299.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14530.28,"maximum":77186.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50737.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47483.15},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50737.58},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44978.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41943.66},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39197.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19373.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19373.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14530.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77186.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12378.86,"maximum":65316.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42935.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40181.28},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42935.24},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38062.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35493.64},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33169.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16505.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16505.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12378.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65316.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5959.39,"maximum":29900.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19654.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18393.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19654.47},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17423.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16247.93},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15184.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7945.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7945.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5959.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29900.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":7779.18,"10th_percentile":7779.18,"90th_percentile":7779.18,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":14547.81,"10th_percentile":14547.81,"90th_percentile":14547.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18676.48,"maximum":100061.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65774.17},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61555.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65774.17},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58308.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54374.09},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50814.19},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24901.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24901.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18676.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100061.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10778.76,"maximum":56489.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37132.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34750.6},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37132.36},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32917.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30696.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28686.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14371.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14371.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56489.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14246.19,"maximum":75619.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49707.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46518.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49707.31},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44065.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41091.96},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38401.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18994.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18994.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14246.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75619.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12299.13,"maximum":64877.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42646.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39910.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42646.11},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37805.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35254.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32946.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16398.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16398.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12299.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64877.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":21153.54,"maximum":113727.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":74757.45},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":69962.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":74757.45},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66272.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61800.37},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57754.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28204.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28204.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21153.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113727.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18308.18,"maximum":98029.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64438.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":60305.26},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64438.49},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57124.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53269.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49782.3},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24410.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24410.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18308.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98029.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9042.23,"maximum":46908.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30834.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28856.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30834.7},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27334.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25490.38},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23821.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12056.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12056.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9042.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46908.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9167.44,"maximum":47599.28,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31288.75},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29281.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31288.75},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27737.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25865.73},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24172.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12223.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12223.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9167.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47599.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7737.46,"maximum":39709.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26102.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24428.51},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26102.8},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23140.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21578.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20165.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7737.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39709.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6311.41,"maximum":31842.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20931.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19588.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20931.11},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18555.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17303.3},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16170.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6311.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31842.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":6713.71,"10th_percentile":6713.71,"90th_percentile":6713.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":8012.47,"10th_percentile":8012.47,"90th_percentile":8012.47,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9950.08,"maximum":51917.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34127.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31938.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34127.07},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30253.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28212.12},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26365.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13266.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13266.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9950.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51917.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11010.07,"maximum":57765.28,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37971.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35535.67},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37971.23},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33661.45},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31390.0},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29334.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11010.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57765.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":17052.25,"maximum":91100.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59883.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":56042.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":59883.74},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53086.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49504.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46263.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22736.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22736.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17052.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91100.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9558.76,"maximum":49758.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32707.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30609.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32707.91},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28995.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27038.92},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25268.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9558.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49758.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11405.32,"maximum":59945.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39404.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36877.14},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39404.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34932.17},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32574.97},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30442.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15207.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15207.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59945.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6387.76,"maximum":32263.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21208.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19847.69},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21208.02},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18800.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17532.21},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16384.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6387.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32263.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12845.41,"maximum":67891.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44627.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41764.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44627.24},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39561.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36892.38},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34477.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17127.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17127.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12845.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67891.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6926.18,"maximum":35234.06,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23160.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21675.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23160.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20531.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19146.4},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17892.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9234.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9234.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6926.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35234.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5932.44,"maximum":29751.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19556.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18302.33},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19556.74},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17337.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16167.14},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15108.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7909.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7909.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29751.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6169.36,"maximum":31058.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20415.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19106.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20415.97},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18098.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16877.45},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15772.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8225.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8225.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6169.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31058.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5922.89,"maximum":29698.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19522.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18269.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19522.13},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17306.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16138.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15081.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7897.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7897.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5922.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29698.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":23092.0,"10th_percentile":23092.0,"90th_percentile":23092.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent 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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":17295.0,"10th_percentile":17295.0,"90th_percentile":17295.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4209.01,"10th_percentile":4209.01,"90th_percentile":4209.01,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4209.01,"10th_percentile":4209.01,"90th_percentile":4209.01,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":21184.61,"10th_percentile":21184.61,"90th_percentile":21184.61},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":19731.74,"10th_percentile":19731.74,"90th_percentile":19731.74,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7091.8,"maximum":36147.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23761.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22237.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23761.29},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21064.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19642.94},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18356.91},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7091.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36147.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8152.92,"maximum":42002.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27609.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25838.58},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27609.52},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24475.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22824.19},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21329.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10870.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10870.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8152.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42002.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5694.95,"maximum":28441.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18695.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17496.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18695.47},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16573.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15455.14},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14443.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7593.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7593.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5694.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28441.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":9322.39,"10th_percentile":9322.39,"90th_percentile":9322.39,"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 Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":8422.91,"10th_percentile":8422.91,"90th_percentile":8422.91,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":33466.96,"maximum":181662.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":119413.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":111753.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":119413.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105859.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98716.31},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92253.3},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44622.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44622.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33466.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":181662.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10105.6,"maximum":52775.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34691.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32465.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34691.07},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30753.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28678.36},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26800.77},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13474.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13474.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52775.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7386.56,"maximum":37774.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24830.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23237.57},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24830.24},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22011.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20526.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19182.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9848.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9848.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7386.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37774.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7374.77,"maximum":37708.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24787.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23197.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24787.48},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21974.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20491.28},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19149.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9833.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9833.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37708.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11757.9,"maximum":61891.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40683.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38073.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40683.31},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36065.71},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33632.02},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31430.11},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15677.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15677.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11757.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61891.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8951.84,"maximum":46409.84,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30506.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28550.11},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30506.89},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27044.32},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25219.39},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23568.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11935.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11935.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46409.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":22238.8,"maximum":119715.28,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":78693.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":73645.67},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":78693.23},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69761.45},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65054.0},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60794.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29651.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29651.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22238.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119715.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11579.37,"maximum":60906.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40035.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37467.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40035.83},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35491.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33096.76},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30929.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15439.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15439.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11579.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60906.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5496.2,"maximum":27344.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17974.69},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16821.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17974.69},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15934.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14859.29},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13886.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7328.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7328.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5496.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27344.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":16810.32,"10th_percentile":16810.32,"90th_percentile":16810.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7515.44,"10th_percentile":7515.44,"90th_percentile":7515.44,"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":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4175.99,"10th_percentile":4175.99,"90th_percentile":4175.99,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11741.62,"maximum":61801.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40624.27},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38018.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40624.27},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36013.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33583.21},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31384.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15655.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15655.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61801.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10818.62,"maximum":56709.03,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37276.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34885.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37276.92},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33045.94},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30816.03},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28798.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10818.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56709.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8765.03,"10th_percentile":8765.03,"90th_percentile":8765.03,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":22403.3,"maximum":120622.85,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":79289.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":74203.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":79289.81},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70290.31},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65547.17},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61255.77},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29871.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29871.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22403.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120622.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7666.72,"maximum":39319.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25846.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24188.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25846.25},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22912.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21366.54},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19967.66},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10222.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10222.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7666.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39319.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":11497.89,"10th_percentile":11497.89,"90th_percentile":11497.89,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":24198.21,"maximum":130525.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":85799.22},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":80295.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":85799.22},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76060.9},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70928.36},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66284.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32264.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32264.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24198.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130525.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7810.45,"maximum":40112.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26367.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24676.23},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26367.5},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23374.75},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21797.44},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20370.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10413.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10413.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40112.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7272.58,"maximum":37145.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24416.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22850.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24416.91},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21645.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20184.93},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18863.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7272.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37145.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8987.78,"maximum":46608.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30637.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28672.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30637.2},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27159.84},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25327.11},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23668.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11983.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11983.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8987.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46608.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9988.25,"maximum":52127.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34265.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32067.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34265.53},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30376.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28326.57},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26472.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13317.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13317.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9988.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52127.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":31459.81,"10th_percentile":31459.81,"90th_percentile":31459.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":31709.63,"10th_percentile":31709.63,"90th_percentile":31709.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":24835.44,"maximum":134041.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":88110.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":82458.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":88110.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78109.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72838.8},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68070.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33113.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33113.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24835.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134041.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12963.31,"maximum":68541.48,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45054.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42164.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45054.82},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39941.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37245.85},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34807.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12963.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68541.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":31790.52,"maximum":172413.05,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":113333.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":106063.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":113333.4},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100469.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93690.28},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87556.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42387.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42387.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31790.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":172413.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":30162.92,"maximum":163433.39,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":107430.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":100539.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":107430.74},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95237.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88810.68},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82996.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40217.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40217.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30162.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163433.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9690.7,"maximum":50486.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33186.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31057.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33186.39},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29419.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27434.48},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25638.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12920.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12920.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9690.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50486.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10542.95,"maximum":55188.16,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36277.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33950.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36277.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32159.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29989.57},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28026.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10542.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55188.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18465.38,"maximum":98896.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65008.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":60838.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65008.6},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57630.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53741.21},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50222.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24620.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24620.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18465.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98896.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":34577.49,"maximum":187789.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":123440.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":115522.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":123440.6},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109429.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102045.68},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95364.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46103.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46103.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34577.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":187789.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":37455.97,"maximum":203669.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":133879.68},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":125292.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":133879.68},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118684.17},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110675.45},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103429.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49941.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49941.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37455.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203669.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5823.52,"maximum":29150.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19161.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17932.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19161.74},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16986.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15840.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14803.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7764.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7764.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5823.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29150.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4560.85,"maximum":22184.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14582.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13647.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14582.55},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12927.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12055.08},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11265.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6081.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6081.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4560.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22184.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6758.87,"maximum":34311.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22553.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21107.22},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22553.88},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19993.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18644.81},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17424.12},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9011.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9011.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6758.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34311.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":20594.89,"10th_percentile":20594.89,"90th_percentile":20594.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5841.34,"10th_percentile":5841.34,"90th_percentile":5841.34,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":28708.18,"10th_percentile":28708.18,"90th_percentile":28708.18},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4771.95,"maximum":23348.96,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15348.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14363.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15348.12},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13606.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12687.96},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11857.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6362.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4771.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23348.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":17250.44,"maximum":92193.99,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":60602.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":56715.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":60602.48},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53724.02},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50098.76},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46818.77},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23000.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23000.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17250.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92193.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5647.79,"maximum":28181.06,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18524.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17336.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18524.44},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16421.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15313.75},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14311.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7530.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7530.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5647.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28181.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6272.11,"maximum":31625.48,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20788.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19455.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20788.58},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18429.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17185.47},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16060.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8362.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8362.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6272.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31625.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":8035.42,"10th_percentile":8035.42,"90th_percentile":8035.42,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13596.04,"maximum":72032.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47349.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44312.4},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47349.51},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41975.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39142.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36580.12},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13596.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72032.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15040.62,"maximum":80002.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52588.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49215.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52588.39},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46619.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43473.69},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40627.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20054.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20054.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15040.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80002.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":3902.29,"maximum":18550.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12194.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11412.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12194.2},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10810.15},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10080.68},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9420.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5203.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5203.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3902.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18550.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":26469.78,"maximum":143058.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":94037.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":88005.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":94037.28},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83363.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77738.59},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72649.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35293.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35293.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26469.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143058.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":24250.42,"maximum":130813.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":85988.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":80473.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":85988.58},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76228.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71084.9},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66430.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32333.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32333.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24250.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130813.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11153.8,"maximum":58558.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38492.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36023.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38492.47},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34123.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31820.9},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29737.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14871.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14871.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11153.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58558.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15112.48,"maximum":80398.71,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52849.01},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49459.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52849.01},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46850.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43689.14},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40828.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20149.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20149.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80398.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8312.37,"maximum":42881.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28187.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26379.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28187.77},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24988.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23302.22},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21776.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11083.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11083.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8312.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42881.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":47868.37,"maximum":261116.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":171641.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":160631.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":171641.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":152159.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":141892.08},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":132602.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63824.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63824.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47868.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":261116.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":55464.04,"maximum":303022.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":199187.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":186411.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":199187.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":176579.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":164664.09},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":153883.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73952.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73952.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55464.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":303022.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10819.74,"maximum":56715.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37280.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34889.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37280.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33049.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30819.39},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28801.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10819.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56715.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5868.44,"maximum":29398.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19324.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18085.1},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19324.63},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17131.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15975.25},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14929.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7824.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5868.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29398.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7475.83,"maximum":38266.52,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25153.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23540.55},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25153.98},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22298.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20794.25},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19432.84},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9967.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9967.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7475.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38266.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":23628.23,"10th_percentile":23628.23,"90th_percentile":23628.23,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":9868.62,"10th_percentile":9868.62,"90th_percentile":9868.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5546.9,"10th_percentile":5546.9,"90th_percentile":5546.9,"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":9510.13,"10th_percentile":9510.13,"90th_percentile":11109.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":11109.56,"10th_percentile":11109.56,"90th_percentile":11109.56,"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":"1 through 10","median_amount":31766.73,"10th_percentile":31766.73,"90th_percentile":31766.73},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":24723.58,"10th_percentile":24723.58,"90th_percentile":24723.58,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6552.82,"maximum":33174.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21806.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20407.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21806.63},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19331.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18027.07},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16846.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8737.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8737.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6552.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33174.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7350.21,"10th_percentile":7350.21,"90th_percentile":7350.21,"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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8211.31,"maximum":42324.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27821.27},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26036.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27821.27},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24663.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22999.24},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21493.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10948.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10948.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42324.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5793.2,"maximum":28983.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19051.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17829.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19051.79},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16889.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15749.7},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14718.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7724.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7724.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5793.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28983.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":6936.22,"10th_percentile":6936.22,"90th_percentile":6936.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":3094.94,"maximum":14096.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":9266.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":8671.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":9266.29},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8214.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7660.24},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7158.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4126.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4126.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3094.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14096.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15733.43,"maximum":83824.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55100.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51566.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55100.94},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48846.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45550.76},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42568.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15733.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83824.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9545.84,"maximum":49687.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32661.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30566.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32661.08},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28954.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27000.21},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25232.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12727.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12727.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49687.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":14504.86,"10th_percentile":14504.86,"90th_percentile":14504.86,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14873.32,"maximum":79079.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51981.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48647.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51981.63},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46081.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42972.1},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40158.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19831.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19831.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14873.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79079.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":19295.19,"maximum":103475.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":68017.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":63655.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":68017.96},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60297.83},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56228.98},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52547.64},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25726.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25726.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19295.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103475.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10072.47,"maximum":52592.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34570.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32353.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34570.94},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30647.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28579.05},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26707.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13429.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13429.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10072.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52592.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10687.81,"maximum":55987.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36802.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34441.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36802.51},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32625.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30423.84},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28431.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14250.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14250.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55987.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":31209.43,"maximum":169207.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":111226.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":104091.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":111226.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98601.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91948.17},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85928.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41612.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41612.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31209.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":169207.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":43648.61,"maximum":237835.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":156337.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":146310.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":156337.87},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":138593.32},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":129241.15},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120779.66},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58198.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58198.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43648.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237835.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15972.04,"maximum":85140.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55966.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52376.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55966.28},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49614.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46266.12},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43237.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21296.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21296.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15972.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85140.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6711.71,"maximum":34050.82,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22382.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20947.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22382.85},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19842.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18503.42},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17291.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8948.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8948.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6711.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34050.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4144.27,"maximum":19885.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13071.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12233.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13071.76},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11588.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10806.14},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10098.66},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5525.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5525.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4144.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19885.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":12891.36,"10th_percentile":12891.36,"90th_percentile":12891.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6514.09,"maximum":32960.5,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21666.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20276.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21666.14},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19207.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17910.93},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16738.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8685.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8685.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6514.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32960.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5059.4,"maximum":24934.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16390.61},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15339.28},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16390.61},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14530.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13549.76},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12662.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6745.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6745.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5059.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24934.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":25702.3,"maximum":138823.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":91253.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":85400.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":91253.93},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80896.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75437.66},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70498.71},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34269.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34269.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25702.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138823.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7177.15,"maximum":36618.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24070.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22526.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24070.77},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21338.71},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19898.79},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18596.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9569.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7177.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36618.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10268.98,"maximum":53676.58,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35283.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33020.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35283.58},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31278.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29168.17},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27258.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13691.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13691.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10268.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53676.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6240.1,"maximum":31448.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20672.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19346.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20672.52},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18326.17},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17089.53},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15970.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8320.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8320.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6240.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31448.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10691.18,"maximum":56005.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36814.72},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34453.35},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36814.72},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32636.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30433.94},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28441.41},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14254.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14254.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10691.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56005.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8188.85,"maximum":42200.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27739.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25960.53},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27739.83},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24591.32},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22931.92},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21430.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10918.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10918.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8188.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42200.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10399.79,"maximum":54398.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35757.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33464.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35757.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31699.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29560.36},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27625.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10399.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54398.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8376.38,"maximum":43234.91,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28419.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26596.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28419.88},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25194.19},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23494.11},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21955.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8376.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43234.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4785.43,"maximum":23423.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15396.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14409.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15396.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13649.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12728.36},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11895.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6380.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6380.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4785.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23423.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11830.33,"maximum":62290.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40945.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38319.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40945.97},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36298.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33849.15},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31633.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15773.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15773.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11830.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62290.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13582.58,"maximum":71958.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47300.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44266.67},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47300.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41931.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39102.42},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36542.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13582.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71958.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7139.53,"maximum":36411.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23934.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22399.15},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23934.36},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21217.78},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19786.02},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18490.62},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9519.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9519.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7139.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36411.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":25695.0,"maximum":138783.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":91227.46},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":85375.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":91227.46},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80873.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75415.78},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70478.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34260.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34260.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25695.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138783.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":32711.84,"maximum":177496.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":116674.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":109190.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":116674.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103431.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96452.41},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90137.62},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43615.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43615.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32711.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":177496.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":68012.71,"maximum":372254.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":244696.46},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":229001.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":244696.46},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":216923.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":202285.29},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":189041.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90683.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68012.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":372254.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":58426.75,"maximum":319367.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":209932.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":196466.58},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":209932.09},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":186104.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":173546.34},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":162184.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77902.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77902.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58426.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":319367.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13001.48,"maximum":68752.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45193.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42294.48},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45193.28},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40063.78},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37360.31},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34914.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17335.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17335.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13001.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68752.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12143.05,"maximum":64016.03,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42080.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39380.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42080.08},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37303.94},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34786.69},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32509.19},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16190.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16190.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12143.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64016.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":23856.3,"maximum":128639.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":84559.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":79135.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":84559.23},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74961.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69903.3},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65326.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31808.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31808.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23856.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128639.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11590.04,"maximum":60965.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40074.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37504.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40074.52},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35526.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33128.74},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30959.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15453.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15453.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11590.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60965.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":28540.92,"maximum":154484.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":101548.45},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":95034.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":101548.45},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90022.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83947.92},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78451.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38054.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38054.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28540.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154484.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16491.84,"10th_percentile":16491.84,"90th_percentile":16491.84,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14138.96,"maximum":75027.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49318.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46155.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49318.41},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43720.71},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40770.47},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38101.21},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18851.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18851.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75027.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":3718.13,"maximum":17534.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11526.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10787.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11526.36},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10218.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9528.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8904.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4957.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4957.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3718.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17534.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"1 through 10","median_amount":20066.55,"10th_percentile":20066.55,"90th_percentile":20066.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14323.66,"maximum":76046.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49988.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46781.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49988.29},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44314.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41324.24},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38618.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19098.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19098.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14323.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76046.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":23328.55,"maximum":125727.53,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":82645.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":77344.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":82645.3},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73264.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68321.09},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63848.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31104.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31104.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23328.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125727.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":25966.74,"maximum":140282.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":92212.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":86298.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":92212.93},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81746.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76230.44},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71239.6},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34622.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34622.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25966.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140282.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4325.05,"maximum":20883.35,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13727.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12846.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13727.39},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12169.31},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11348.13},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10605.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5766.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5766.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20883.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":10076.0,"10th_percentile":10076.0,"90th_percentile":10076.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent 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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":9976.0,"10th_percentile":9976.0,"90th_percentile":9976.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2808.93,"10th_percentile":2576.59,"90th_percentile":2921.93,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2576.59,"10th_percentile":2576.59,"90th_percentile":2576.59,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2576.59,"10th_percentile":2576.59,"90th_percentile":2576.59,"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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":11879.32,"10th_percentile":11262.0,"90th_percentile":12916.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"1 through 10","median_amount":8035.17,"10th_percentile":8035.17,"90th_percentile":8035.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6232.81,"maximum":31408.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20646.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19321.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20646.05},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18302.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17067.65},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15950.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8310.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8310.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6232.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31408.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":26280.58,"maximum":142014.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":93351.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":87363.36},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":93351.11},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82755.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77171.35},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72118.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35040.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35040.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26280.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142014.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7291.12,"maximum":37247.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24484.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22913.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24484.1},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21705.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20240.48},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18915.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9721.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9721.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7291.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37247.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4638.91,"10th_percentile":4638.91,"90th_percentile":4638.91,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8646.42,"maximum":44724.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29399.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27513.51},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29399.25},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26062.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24303.72},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22712.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11528.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44724.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7884.56,"maximum":40521.5,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26636.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24927.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26636.26},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23613.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22019.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20577.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10512.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10512.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40521.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12563.0,"maximum":66332.96,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43603.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40806.28},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43603.08},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38654.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36045.73},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33685.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16750.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16750.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12563.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66332.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6328.82,"maximum":31938.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20994.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19647.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20994.23},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18611.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17355.48},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16219.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8438.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8438.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6328.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31938.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5571.44,"maximum":27759.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18247.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17077.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18247.53},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16176.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15084.84},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14097.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7428.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7428.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5571.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27759.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":7148.47,"10th_percentile":7148.47,"90th_percentile":7148.47,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":7075.93,"10th_percentile":7075.93,"90th_percentile":7075.93,"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"1 through 10","median_amount":19829.91,"10th_percentile":19829.91,"90th_percentile":19829.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":26935.22,"maximum":145625.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":95725.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":89585.18},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":95725.21},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84860.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79133.96},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73953.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35913.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35913.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26935.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145625.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9252.21,"maximum":48067.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31596.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29569.55},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31596.2},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28009.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26119.9},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24409.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12336.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12336.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9252.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48067.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10361.05,"maximum":54184.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35617.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33332.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35617.5},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31574.87},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29444.22},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27516.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13814.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13814.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10361.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54184.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13669.6,"maximum":72438.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47616.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44562.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47616.23},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42211.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39363.32},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36786.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18226.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18226.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13669.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72438.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7054.19,"maximum":35940.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23624.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22109.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23624.87},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20943.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19530.17},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18251.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35940.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":8897.7,"10th_percentile":8897.7,"90th_percentile":8897.7,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6238.42,"maximum":31439.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20666.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19340.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20666.42},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18320.75},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17084.48},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15965.95},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8317.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8317.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6238.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31439.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":9284.88,"10th_percentile":9284.88,"90th_percentile":9284.88,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":7625.33,"10th_percentile":7625.33,"90th_percentile":7625.33,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":9292.13,"10th_percentile":9292.13,"90th_percentile":9292.13,"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8980.48,"maximum":46567.82,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30610.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28647.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30610.73},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27136.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25305.23},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23648.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11973.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11973.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46567.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4221.18,"maximum":20310.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13350.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12494.36},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13350.71},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11835.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11036.74},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10314.16},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5628.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5628.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4221.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20310.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8093.97,"maximum":41676.86,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27395.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25638.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27395.73},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24286.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22647.46},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21164.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10791.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10791.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8093.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41676.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7505.59,"maximum":38430.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25261.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23641.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25261.89},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22394.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20883.46},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19516.21},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10007.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10007.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7505.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38430.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5729.2,"maximum":28630.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18819.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17612.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18819.67},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16683.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15557.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14539.24},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5729.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28630.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5339.0,"maximum":26477.43,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17404.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16288.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17404.58},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15429.14},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14387.99},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13446.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7118.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7118.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5339.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26477.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5427.7,"maximum":26966.84,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17726.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16589.28},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17726.29},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15714.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14653.94},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13694.54},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5427.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26966.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20588.18,"maximum":110608.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72707.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":68043.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72707.09},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64454.75},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60105.39},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56170.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27450.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27450.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20588.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110608.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14262.47,"maximum":75709.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49766.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46574.23},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49766.36},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44117.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41140.77},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38447.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19016.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19016.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14262.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75709.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":25596.19,"maximum":138238.33,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":90869.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":85040.56},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":90869.11},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80555.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75119.53},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70201.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34128.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34128.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25596.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138238.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4480.57,"maximum":21741.35,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14291.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13374.7},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14291.39},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12669.3},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11814.38},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11040.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5974.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5974.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4480.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21741.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4319.43,"maximum":20852.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13707.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12827.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13707.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12151.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11331.3},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10589.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5759.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5759.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4319.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20852.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":3717.57,"maximum":17531.85,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11524.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10785.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11524.33},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10216.3},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9526.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8903.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4956.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4956.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3717.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17531.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10178.58,"maximum":53177.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34955.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32713.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34955.76},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30988.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28897.18},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27005.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13571.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13571.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10178.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53177.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4759.6,"maximum":23280.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15303.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14321.74},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15303.33},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13566.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12650.93},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11822.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6346.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6346.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4759.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23280.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":6251.95,"10th_percentile":6251.95,"90th_percentile":6799.95,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12785.33,"maximum":67559.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44409.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41560.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44409.38},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39368.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36712.28},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34308.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12785.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67559.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7968.21,"maximum":40983.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26939.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25211.67},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26939.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23881.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22270.42},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20812.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10624.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7968.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40983.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13739.78,"maximum":72825.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47870.75},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44800.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47870.75},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42437.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39573.72},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36982.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18319.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18319.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13739.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72825.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15020.41,"maximum":79890.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52515.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49146.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52515.09},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46554.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43413.09},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40570.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20027.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15020.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79890.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8129.34,"maximum":41872.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27524.0},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25758.55},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27524.0},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24399.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22753.5},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21263.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8129.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41872.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10701.84,"maximum":56064.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36853.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34489.55},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36853.41},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32670.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30465.92},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28471.3},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14269.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14269.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10701.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56064.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5024.6,"maximum":24742.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16264.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15221.13},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16264.37},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14418.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13445.4},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12565.12},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6699.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6699.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5024.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24742.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16019.2,"maximum":85401.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56137.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52536.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":56137.31},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49765.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46407.51},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43369.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21358.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21358.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16019.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85401.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6037.42,"maximum":30330.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19937.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18658.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19937.49},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17674.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16481.89},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15402.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8049.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8049.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6037.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30330.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11447.43,"maximum":60178.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39557.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37020.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39557.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35067.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32701.21},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30560.24},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15263.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15263.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11447.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60178.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":34272.63,"maximum":186107.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":122335.0},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":114488.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":122335.0},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":108449.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101131.71},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94510.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45696.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45696.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34272.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186107.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":44718.15,"maximum":243736.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":160216.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":149939.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":160216.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":142031.84},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":132447.64},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":123776.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44718.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":243736.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":31161.14,"maximum":168940.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":111050.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":103927.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":111050.93},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98446.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91803.41},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85792.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41548.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41548.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31161.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168940.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":64160.69,"maximum":351002.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":230726.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":215927.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":230726.78},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":204538.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":190736.86},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":178249.21},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85547.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85547.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64160.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":351002.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9037.75,"maximum":46883.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30818.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28841.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30818.41},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27320.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25476.92},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23808.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9037.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46883.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":28452.12,"10th_percentile":28452.12,"90th_percentile":28452.12},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9453.76,"maximum":49179.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32327.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30253.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32327.16},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28657.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26724.17},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24974.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9453.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49179.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10037.1,"maximum":52397.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34442.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32233.44},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34442.67},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30533.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28473.01},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26608.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13382.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52397.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":24978.85,"10th_percentile":24978.85,"90th_percentile":24978.85,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":62416.88,"maximum":341381.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":224402.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":210008.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":224402.65},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":198932.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":185508.84},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":173363.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83222.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83222.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62416.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":341381.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10851.74,"maximum":56891.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37397.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34998.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37397.05},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33152.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30915.33},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28891.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14468.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14468.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10851.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56891.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":12390.86,"10th_percentile":12390.86,"90th_percentile":12390.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4468.22,"maximum":21673.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14246.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13332.78},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14246.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12629.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11777.35},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11006.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5957.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5957.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4468.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21673.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5418.88,"10th_percentile":5418.88,"90th_percentile":5418.88,"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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":47719.59,"maximum":260295.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":171101.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":160126.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":171101.63},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":151681.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":141446.03},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":132185.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63626.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63626.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47719.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":260295.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":29764.85,"maximum":161237.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":105987.15},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":99188.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":105987.15},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93957.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87617.29},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81880.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39686.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39686.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29764.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161237.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":24641.74,"maximum":132972.58,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":87407.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":81801.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":87407.74},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77486.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72258.09},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67527.32},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32855.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32855.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24641.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132972.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9696.87,"maximum":50520.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33208.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31078.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33208.79},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29439.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27452.99},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25655.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12929.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12929.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9696.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50520.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14778.44,"maximum":78555.7,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51637.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48325.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51637.53},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45776.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42687.64},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39892.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19704.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19704.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14778.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78555.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10354.31,"maximum":54147.4,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35593.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33310.05},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35593.06},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31553.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29424.02},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27497.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13805.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13805.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54147.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":17498.03,"maximum":93559.99,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61500.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":57555.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61500.4},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54520.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50841.06},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47512.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23330.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23330.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17498.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93559.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":21522.4,"maximum":115762.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":76095.17},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":71214.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":76095.17},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67458.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62906.23},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58787.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28696.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28696.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21522.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115762.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5074.0,"maximum":25015.41,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16443.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15388.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16443.54},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14577.18},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13593.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12703.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6765.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6765.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5074.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25015.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4776.44,"maximum":23373.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15364.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14378.9},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15364.41},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13620.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12701.43},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11869.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4776.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23373.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":20782.41,"10th_percentile":20782.41,"90th_percentile":20782.41},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5936.93,"maximum":29776.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19573.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18317.57},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19573.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17351.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16180.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15121.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7915.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7915.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5936.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29776.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":8724.04,"10th_percentile":8724.04,"90th_percentile":8724.04,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":44149.26,"10th_percentile":44149.26,"90th_percentile":44149.26},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":23239.56,"10th_percentile":23239.56,"90th_percentile":23239.56},{"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6862.18,"maximum":34880.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22928.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21457.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22928.52},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20326.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18954.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17713.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6862.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34880.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":297.86,"10th_percentile":297.86,"90th_percentile":297.86,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10025.31,"maximum":52332.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34399.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32193.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34399.91},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30495.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28437.66},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26575.84},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13367.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13367.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10025.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52332.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18721.96,"maximum":100312.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65939.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61709.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65939.1},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58454.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54510.43},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50941.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24962.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24962.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18721.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100312.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7200.16,"maximum":36745.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24154.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22604.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24154.25},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21412.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19967.8},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18660.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9600.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7200.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36745.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":3936.53,"maximum":18739.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12318.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11528.28},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12318.41},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10920.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10183.36},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9516.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5248.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5248.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3936.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18739.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8396.02,"maximum":43343.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28491.15},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26663.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28491.15},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25257.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23553.02},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22010.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11194.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11194.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8396.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43343.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6491.63,"maximum":32836.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21584.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20200.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21584.7},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19134.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17843.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16675.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8655.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8655.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6491.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32836.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14290.54,"maximum":75863.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49868.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46669.51},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49868.16},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44208.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41224.93},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38525.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19054.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19054.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14290.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75863.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2143.44,"10th_percentile":2143.44,"90th_percentile":2143.44,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3180.33,"10th_percentile":3180.33,"90th_percentile":3180.33,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10802.9,"maximum":56622.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37219.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34832.54},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37219.91},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32995.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30768.9},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28754.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14403.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14403.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10802.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56622.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":13834.67,"10th_percentile":13834.67,"90th_percentile":13834.67,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16312.84,"maximum":87021.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":57202.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":53533.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":57202.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50709.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47287.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44191.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21750.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21750.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16312.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87021.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12935.8,"maximum":68389.7,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44955.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42071.53},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44955.05},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39852.6},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37163.37},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34730.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17247.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17247.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12935.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68389.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4088.12,"maximum":19576.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12868.15},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12042.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12868.15},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11407.6},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10637.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9941.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5450.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5450.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19576.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13259.74,"maximum":70176.96,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46129.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43171.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46129.88},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40894.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38134.58},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35637.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17679.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17679.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13259.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70176.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4591.17,"maximum":22351.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14692.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13750.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14692.5},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13024.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12145.97},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11350.77},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6121.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6121.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4591.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22351.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":9888.82,"10th_percentile":9888.82,"90th_percentile":9888.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18701.75,"maximum":100201.03,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65865.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61641.02},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65865.8},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58389.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54449.84},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50884.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24935.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24935.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18701.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100201.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5308.68,"maximum":26310.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17294.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16185.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17294.63},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15331.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14297.1},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13361.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7078.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7078.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5308.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26310.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8360.09,"maximum":43145.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28360.84},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26541.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28360.84},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25141.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23445.29},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21910.32},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11146.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11146.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8360.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43145.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4636.64,"maximum":22602.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14857.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13904.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14857.42},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13171.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12282.31},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11478.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6182.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6182.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4636.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22602.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7997.4,"maximum":41144.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27045.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25310.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27045.52},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23975.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22357.95},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20894.16},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10663.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10663.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7997.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41144.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4908.94,"maximum":24104.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15844.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14828.6},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15844.93},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14046.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13098.66},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12241.09},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6545.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6545.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4908.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24104.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":7254.04,"10th_percentile":7254.04,"90th_percentile":7254.04,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":5597.63,"10th_percentile":5597.63,"90th_percentile":5597.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":20349.5,"10th_percentile":20349.5,"90th_percentile":20349.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":29714.32,"maximum":160958.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":105803.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":99017.4},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":105803.9},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93795.02},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87465.8},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81739.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39619.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39619.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29714.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160958.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6352.96,"maximum":32071.52,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21081.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19729.55},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21081.78},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18688.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17427.85},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16286.84},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8470.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8470.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32071.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9253.34,"maximum":48073.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31600.27},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29573.36},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31600.27},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28013.6},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26123.26},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24412.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12337.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12337.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9253.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48073.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5456.9,"maximum":27127.91,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17832.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16688.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17832.16},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15808.19},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14741.47},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13776.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5456.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27127.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":8162.49,"10th_percentile":8162.49,"90th_percentile":8162.49,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4928.59,"maximum":24213.16,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15916.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14895.29},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15916.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14109.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13157.57},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12296.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6571.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6571.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4928.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24213.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9153.4,"maximum":47521.85,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31237.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29234.18},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31237.85},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27692.31},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25823.65},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24132.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12204.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12204.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9153.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47521.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8798.57,"maximum":45564.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29951.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28029.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29951.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26551.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24759.87},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23138.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8798.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45564.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8865.38,"maximum":45932.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30193.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28256.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30193.33},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26766.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24960.17},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23326.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11820.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11820.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8865.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45932.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8784.54,"maximum":45486.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29900.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27982.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29900.13},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26506.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24717.79},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23099.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8784.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45486.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10292.56,"maximum":53806.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35369.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33100.44},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35369.09},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31354.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29238.87},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27324.58},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13723.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13723.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10292.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53806.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8579.05,"maximum":44353.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29154.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27284.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29154.92},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25845.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24101.74},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22523.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11438.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11438.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44353.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4215.57,"maximum":20279.33,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13330.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12475.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13330.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11817.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11019.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10298.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4215.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20279.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3174.97,"10th_percentile":3174.97,"90th_percentile":3174.97,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9423.45,"maximum":49011.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32217.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30150.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32217.21},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28560.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26633.27},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24889.58},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12564.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9423.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49011.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":20818.9,"10th_percentile":20818.9,"90th_percentile":20818.9,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10494.68,"maximum":54921.77,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36102.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33786.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36102.09},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32004.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29844.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27890.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13992.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13992.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10494.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54921.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":25202.62,"maximum":136066.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":89441.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":83704.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":89441.8},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79290.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73939.61},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69098.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33603.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33603.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25202.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136066.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7887.92,"maximum":40540.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26648.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24939.18},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26648.48},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23623.84},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22029.72},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20587.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10517.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10517.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7887.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40540.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9735.61,"maximum":50733.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33349.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31210.18},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33349.28},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29564.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27569.13},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25764.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9735.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50733.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11556.34,"maximum":60779.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39952.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37389.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39952.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35417.71},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33027.75},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30865.41},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15408.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15408.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11556.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60779.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8831.14,"maximum":45743.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30069.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28140.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30069.12},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26656.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24857.5},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23230.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11774.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11774.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8831.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45743.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":11717.64,"10th_percentile":11717.64,"90th_percentile":11717.64,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13985.68,"maximum":74182.03,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48762.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":45634.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48762.56},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43227.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40310.96},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37671.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18647.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18647.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13985.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74182.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9477.35,"maximum":49309.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32412.68},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30333.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32412.68},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28733.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26794.86},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25040.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12636.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12636.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9477.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49309.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":14317.89,"10th_percentile":14317.89,"90th_percentile":14317.89,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16832.73,"maximum":89889.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59087.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":55297.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":59087.62},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52381.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48846.46},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45648.46},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22443.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22443.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16832.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89889.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7220.93,"maximum":36860.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24229.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22675.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24229.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21479.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20030.08},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18718.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9627.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9627.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7220.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36860.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9308.92,"maximum":48379.85,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31801.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29762.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31801.85},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28192.3},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26289.9},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24568.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48379.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8015.37,"maximum":41243.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27110.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25371.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27110.67},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24033.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22411.81},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20944.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8015.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41243.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9502.61,"maximum":49448.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32504.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30419.4},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32504.3},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28815.02},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26870.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25111.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12670.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12670.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9502.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49448.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4850.55,"maximum":23782.61,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15633.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14630.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15633.18},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13858.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12923.61},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12077.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6467.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6467.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4850.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23782.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8136.08,"maximum":41909.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27548.43},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25781.42},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27548.43},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24421.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22773.7},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21282.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10848.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10848.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41909.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20817.8,"maximum":111875.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":73539.86},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":68822.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":73539.86},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65192.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60793.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56813.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27757.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27757.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20817.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111875.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6707.78,"maximum":34029.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22368.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20933.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22368.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19829.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18491.64},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17280.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8943.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8943.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34029.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5568.07,"maximum":27741.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18235.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17065.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18235.31},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16165.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15074.74},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14087.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5568.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27741.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9886.64,"maximum":51567.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33896.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31722.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33896.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30049.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28021.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26187.3},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13182.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13182.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9886.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51567.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10405.4,"maximum":54429.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35778.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33483.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35778.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31717.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29577.19},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27640.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13873.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10405.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54429.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9112.42,"maximum":47295.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31089.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29095.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31089.21},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27560.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25700.78},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24018.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9112.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47295.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":19022.89,"maximum":101972.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":67030.45},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":62730.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":67030.45},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59422.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55412.63},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51784.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25363.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25363.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19022.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101972.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":19693.81,"maximum":105674.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":69463.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65008.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":69463.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61579.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57424.05},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53664.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26258.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26258.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19693.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105674.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":30261.16,"maximum":163975.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":107787.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":100873.36},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":107787.06},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95553.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89105.24},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83271.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40348.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40348.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30261.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163975.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":24210.0,"maximum":130590.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":85841.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":80335.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":85841.98},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76098.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70963.71},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66317.68},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32280.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32280.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24210.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130590.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":119705.84,"maximum":657450.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":432166.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":404446.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":432166.3},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":383114.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":357262.57},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":333872.4},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159607.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159607.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119705.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":657450.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12764.0,"maximum":67441.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44332.01},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41488.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44332.01},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39300.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36648.31},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34248.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17018.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17018.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12764.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67441.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13937.96,"maximum":73918.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48589.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":45472.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48589.49},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43074.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40167.88},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37538.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18583.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18583.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13937.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73918.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8963.07,"maximum":46471.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30547.61},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28588.22},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30547.61},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27080.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25253.05},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23599.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11950.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11950.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8963.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46471.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4540.08,"maximum":22069.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14507.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13576.69},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14507.21},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12860.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11992.8},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11207.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6053.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4540.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22069.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5262.64,"maximum":26056.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17127.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16029.07},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17127.67},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15183.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14159.08},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13232.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7016.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7016.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5262.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26056.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":15494.65,"10th_percentile":15494.65,"90th_percentile":15494.65,"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 Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5342.23,"10th_percentile":5342.23,"90th_percentile":5342.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":38052.78,"maximum":206962.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":136044.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":127317.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":136044.06},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120602.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112464.69},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105101.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50737.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38052.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":206962.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15474.05,"maximum":82393.5,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54160.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":50686.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":54160.26},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48013.0},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44773.12},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41841.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20632.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20632.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15474.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82393.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11369.39,"maximum":59747.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39274.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36755.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39274.33},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34816.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32467.24},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30341.6},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11369.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59747.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":14610.35,"10th_percentile":14610.35,"90th_percentile":14610.35,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14346.69,"maximum":76173.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50071.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46860.06},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50071.77},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44388.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41393.25},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38683.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19128.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14346.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76173.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9333.06,"maximum":48513.05,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31889.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29843.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31889.4},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28269.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26362.28},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24636.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12444.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12444.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9333.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48513.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7323.68,"maximum":37427.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24602.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23024.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24602.2},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21809.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20338.11},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19006.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9764.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9764.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7323.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37427.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10605.28,"maximum":55531.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36503.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34161.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36503.2},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32360.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30176.41},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28200.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14140.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14140.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10605.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55531.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6279.4,"maximum":31665.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20815.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19479.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20815.05},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18452.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17207.35},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16080.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8372.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8372.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6279.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31665.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12429.38,"maximum":65595.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43118.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40352.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43118.49},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38224.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35645.13},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33311.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16572.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16572.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12429.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65595.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":40169.85,"10th_percentile":40169.85,"90th_percentile":40169.85,"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 Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7817.74,"maximum":40152.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26393.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24701.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26393.96},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23398.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21819.32},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20390.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10423.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10423.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7817.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40152.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":1064.14,"10th_percentile":1064.14,"90th_percentile":1064.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11380.62,"maximum":59809.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39315.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36793.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39315.05},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34852.75},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32500.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30373.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15174.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15174.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11380.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59809.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5203.13,"maximum":25727.84,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16911.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15827.08},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16911.85},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14992.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13980.66},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13065.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6937.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6937.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5203.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25727.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9206.18,"maximum":47813.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31429.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29413.3},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31429.24},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27861.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25981.88},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24280.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9206.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47813.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":13935.66,"10th_percentile":13935.66,"90th_percentile":13935.66,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10628.86,"maximum":55662.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36588.72},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34241.84},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36588.72},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32435.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30247.1},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28266.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14171.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14171.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10628.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55662.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10221.26,"maximum":53413.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35110.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32858.44},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35110.51},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31125.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29025.1},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27124.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10221.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53413.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9899.55,"maximum":51638.42,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33943.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31766.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33943.82},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30091.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28060.63},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26223.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13199.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13199.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9899.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51638.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5682.6,"maximum":28373.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18650.68},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17454.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18650.68},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16533.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15418.11},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14408.68},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7576.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7576.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28373.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":7922.41,"10th_percentile":7922.41,"90th_percentile":7922.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":6786.62,"10th_percentile":6786.62,"90th_percentile":6786.62,"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16750.76,"maximum":89437.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58790.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":55019.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":58790.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52117.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48600.72},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45418.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22334.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22334.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16750.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89437.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8825.52,"maximum":45712.91,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30048.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28121.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30048.76},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26638.19},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24840.67},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23214.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11767.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11767.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45712.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":3742.84,"maximum":17671.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11615.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10870.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11615.95},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10297.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9602.66},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8973.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4990.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4990.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3742.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17671.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5917.28,"maximum":29667.86,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19501.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18250.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19501.77},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17288.29},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16121.69},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15066.19},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7889.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7889.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5917.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29667.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":23949.5,"maximum":129153.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":84897.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":79451.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":84897.23},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75261.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70182.71},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65587.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31932.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31932.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23949.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129153.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11257.1,"maximum":59128.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38867.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36374.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38867.11},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34455.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32130.6},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30027.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15009.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15009.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11257.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59128.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7647.07,"maximum":39211.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25774.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24121.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25774.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22849.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21307.63},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19912.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10196.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10196.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7647.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39211.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6332.82,"10th_percentile":6332.82,"90th_percentile":6332.82,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13349.57,"maximum":70672.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46455.66},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43475.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46455.66},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41182.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38403.89},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35889.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17799.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17799.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13349.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70672.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8115.86,"maximum":41797.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27475.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25712.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27475.13},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24356.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22713.1},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21226.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10821.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10821.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8115.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41797.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":3475.59,"maximum":16196.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":10646.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9963.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":10646.77},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9438.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8801.45},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8225.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4634.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4634.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3475.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16196.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9699.11,"maximum":50532.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33216.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31086.33},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33216.94},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29446.77},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27459.72},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25661.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12932.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12932.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50532.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":15751.96,"maximum":83926.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55168.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51629.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55168.13},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48906.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45606.3},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42620.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21002.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21002.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15751.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83926.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10778.76,"maximum":56489.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37132.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34750.6},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37132.36},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32917.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30696.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28686.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14371.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14371.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56489.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":39345.2,"maximum":214093.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":140731.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":131704.35},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":140731.16},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":124757.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":116339.42},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":108722.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52460.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52460.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39345.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":214093.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8038.39,"maximum":41370.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27194.15},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25449.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27194.15},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24107.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22480.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21008.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8038.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41370.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"1 through 10","median_amount":27039.41,"10th_percentile":27039.41,"90th_percentile":27039.41,"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: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":10043.74,"10th_percentile":10043.74,"90th_percentile":10043.74,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18671.43,"maximum":100033.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65755.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61538.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65755.85},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58292.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54358.94},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50800.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24895.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24895.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18671.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100033.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7960.35,"maximum":40939.66,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26911.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25184.99},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26911.13},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23856.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22246.85},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20790.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10613.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10613.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7960.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40939.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16933.78,"maximum":90447.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59454.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":55640.6},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":59454.12},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52706.0},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49149.44},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45931.6},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22578.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22578.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16933.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90447.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8854.72,"maximum":45873.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30154.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28220.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30154.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26732.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24928.19},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23296.13},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11806.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11806.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8854.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45873.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":11371.44,"10th_percentile":11371.44,"90th_percentile":13375.93,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8088.35,"maximum":41645.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27375.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25619.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27375.36},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24268.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22630.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21148.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10784.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10784.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8088.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41645.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11770.25,"maximum":61959.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40728.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38115.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40728.11},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36105.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33669.05},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31464.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15693.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15693.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11770.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61959.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13100.86,"maximum":69300.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45553.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42631.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45553.67},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40383.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37658.23},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35192.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13100.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69300.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4593.41,"maximum":22363.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14700.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13757.71},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14700.64},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13032.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12152.7},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11357.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6124.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6124.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4593.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22363.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12108.8,"maximum":63827.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41955.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39264.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41955.88},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37193.83},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34684.02},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32413.24},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16145.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16145.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63827.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5930.75,"maximum":29742.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19550.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18296.61},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19550.63},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17331.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16162.09},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15103.95},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5930.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29742.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4003.34,"maximum":19108.48,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12560.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11755.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12560.7},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11135.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10383.66},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9703.84},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5337.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5337.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4003.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19108.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":12387.35,"10th_percentile":12387.35,"90th_percentile":12387.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8868.19,"maximum":45948.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30203.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28266.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30203.51},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26775.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24968.59},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23333.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11824.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11824.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8868.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45948.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4280.69,"maximum":20638.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13566.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12696.35},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13566.53},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12026.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11215.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10480.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5707.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4280.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20638.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6890.25,"maximum":35035.82,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23030.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21553.11},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23030.33},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20416.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19038.68},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17792.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6890.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35035.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9920.88,"maximum":51756.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34021.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31839.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34021.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30159.75},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28124.59},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26283.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9920.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51756.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":34018.86,"maximum":184707.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":121414.68},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":113626.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":121414.68},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107633.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100370.9},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93799.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45358.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45358.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34018.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":184707.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20339.46,"maximum":109236.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":71805.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":67199.36},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":71805.1},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63655.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59359.73},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55473.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27119.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27119.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20339.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109236.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13316.45,"maximum":70489.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46335.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43363.46},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46335.53},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41076.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38304.58},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35796.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17755.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17755.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13316.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70489.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16102.3,"maximum":85859.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56438.66},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52818.55},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":56438.66},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50032.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46656.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43601.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21469.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21469.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16102.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85859.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11805.07,"maximum":62151.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40854.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38233.86},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40854.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36217.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33773.41},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31562.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15740.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15740.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11805.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62151.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8096.21,"maximum":41689.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27403.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25646.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27403.87},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24293.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22654.19},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21171.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10794.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10794.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8096.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41689.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12214.35,"maximum":64409.42,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42338.66},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39622.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42338.66},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37533.17},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35000.46},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32708.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16285.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16285.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64409.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":17266.63,"10th_percentile":17266.63,"90th_percentile":17266.63,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11769.69,"maximum":61956.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40726.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38113.81},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40726.07},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36103.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33667.37},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31463.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15692.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15692.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61956.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5897.63,"maximum":29559.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19430.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18184.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19430.5},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17225.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16062.78},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15011.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7863.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7863.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5897.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29559.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14473.01,"maximum":76870.66,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50529.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47288.79},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50529.89},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44794.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41771.97},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39037.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19297.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19297.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14473.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76870.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7817.74,"maximum":40152.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26393.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24701.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26393.96},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23398.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21819.32},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20390.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10423.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10423.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7817.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40152.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5053.23,"maximum":24900.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16368.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15318.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16368.21},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14510.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13531.24},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12645.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5053.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24900.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6975.58,"maximum":35506.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23339.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21842.75},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23339.81},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20690.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19294.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18031.3},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9300.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9300.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6975.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35506.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10241.47,"maximum":53524.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35183.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32927.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35183.81},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31190.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29085.7},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27181.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53524.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5406.38,"maximum":26849.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17648.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16516.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17648.91},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15645.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14589.98},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13634.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7208.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7208.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5406.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26849.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8519.54,"maximum":44024.77,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28939.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27082.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28939.09},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25654.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23923.32},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22357.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8519.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44024.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":11446.19,"10th_percentile":11446.19,"90th_percentile":11446.19,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7319.7,"10th_percentile":7319.7,"90th_percentile":7319.7,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":11568.03,"10th_percentile":11568.03,"90th_percentile":11568.03,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20119.37,"maximum":108022.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":71006.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":66452.41},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":71006.95},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62947.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58699.92},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54856.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26825.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26825.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20119.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108022.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":120409.33,"maximum":661331.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":434717.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":406833.78},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":434717.53},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":385376.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":359371.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":335843.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160545.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160545.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120409.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":661331.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11924.08,"maximum":62808.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41286.0},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38637.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41286.0},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36599.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34130.25},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31895.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15898.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15898.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11924.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62808.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":38330.69,"maximum":208495.82,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":137051.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":128261.11},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":137051.93},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":121496.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":113297.88},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105880.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51107.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51107.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38330.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":208495.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":34907.05,"maximum":189607.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":124635.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":116641.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":124635.79},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110489.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103033.72},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96288.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46542.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46542.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34907.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":189607.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10162.86,"maximum":53091.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34898.75},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32660.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34898.75},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30937.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28850.05},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26961.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13550.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13550.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10162.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53091.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9572.79,"maximum":49835.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32758.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30657.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32758.81},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29040.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27081.0},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25308.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12763.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12763.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9572.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49835.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":14778.92,"10th_percentile":14778.92,"90th_percentile":14778.92,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":24101.08,"maximum":129989.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":85446.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":79966.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":85446.97},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75748.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70637.17},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66012.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32134.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32134.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24101.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129989.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7909.82,"maximum":40660.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26727.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25013.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26727.88},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23694.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22095.37},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20648.77},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7909.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40660.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6167.12,"maximum":31046.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20407.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19098.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20407.83},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18091.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16870.71},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15766.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6167.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31046.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":9264.92,"10th_percentile":9264.92,"90th_percentile":9264.92,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12950.96,"maximum":68473.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45010.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42122.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45010.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39901.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37208.82},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34772.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17267.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17267.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12950.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68473.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5034.14,"maximum":24795.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16298.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15253.53},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16298.98},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14449.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13474.02},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12591.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6712.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6712.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5034.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24795.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":17069.09,"maximum":91193.5,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59944.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":56099.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":59944.82},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53141.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49555.09},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46310.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22758.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22758.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17069.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91193.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5607.93,"maximum":27961.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18379.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17200.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18379.87},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16293.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15194.25},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14199.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27961.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":21463.46,"maximum":115437.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":75881.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":71014.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":75881.37},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67268.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62729.5},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58622.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28617.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28617.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21463.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115437.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5366.51,"maximum":26629.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17504.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16381.58},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17504.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15517.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14470.47},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13523.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7155.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7155.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26629.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6036.31,"maximum":30324.53,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19933.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18654.85},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19933.42},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17670.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16478.53},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15399.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8048.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8048.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30324.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5263.21,"maximum":26059.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17129.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16030.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17129.71},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15185.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14160.76},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13233.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7017.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5263.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26059.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6623.0,"maximum":33561.41,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22061.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20646.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22061.14},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19557.18},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18237.47},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17043.46},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6623.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33561.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4974.07,"maximum":24464.06,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16081.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15049.64},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16081.12},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14255.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13293.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12423.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6632.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6632.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4974.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24464.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":6709.96,"10th_percentile":6709.96,"90th_percentile":6709.96,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14094.6,"maximum":74782.94,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49157.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46004.49},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49157.56},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43578.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40637.5},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37976.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18792.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18792.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14094.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74782.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7096.3,"maximum":36172.61,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23777.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22252.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23777.58},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21078.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19656.41},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18369.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9461.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9461.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7096.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36172.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5948.16,"maximum":29838.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19613.75},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18355.68},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19613.75},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17387.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16214.27},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15152.71},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5948.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29838.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5666.88,"maximum":28286.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18593.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17401.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18593.67},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16483.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15370.98},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14364.64},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7555.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7555.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5666.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28286.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4028.61,"maximum":19247.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":12652.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11840.78},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":12652.33},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11216.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10459.4},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9774.62},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5371.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5371.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4028.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19247.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4043.51,"10th_percentile":4043.51,"90th_percentile":4043.51,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":24349.24,"maximum":131358.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":86346.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":80808.44},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":86346.93},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76546.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71381.15},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66707.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32465.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32465.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24349.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131358.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":32538.91,"maximum":176542.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":116047.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":108603.97},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":116047.52},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102875.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95933.98},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89653.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43385.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43385.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32538.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176542.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":27649.92,"maximum":149568.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":98317.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":92010.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":98317.16},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87158.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81276.68},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75955.45},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36866.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36866.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27649.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149568.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10976.38,"maximum":57579.43,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37849.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35421.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37849.06},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33553.15},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31289.0},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29240.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14635.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14635.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10976.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57579.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10471.1,"maximum":54791.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36016.57},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33706.39},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36016.57},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31928.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29774.12},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27824.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13961.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13961.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10471.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54791.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":17477.26,"maximum":93445.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61425.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":57485.12},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61425.06},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54453.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50778.78},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47454.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23303.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23303.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17477.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93445.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8114.74,"maximum":41791.47,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27471.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25709.01},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27471.06},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24353.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22709.73},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21222.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10819.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10819.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8114.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41791.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18432.26,"maximum":98714.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64888.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":60726.38},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64888.47},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57523.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53641.9},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50129.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24576.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24576.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18432.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98714.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9341.48,"maximum":48559.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31919.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29872.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31919.94},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28296.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26387.53},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24659.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12455.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12455.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9341.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48559.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4960.59,"maximum":24389.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16032.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15003.91},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16032.25},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14212.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13253.52},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12385.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6614.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6614.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4960.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24389.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7317.5,"maximum":37393.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24579.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23003.2},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24579.8},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21789.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20319.59},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18989.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7317.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37393.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8887.84,"maximum":46056.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30274.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28332.88},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30274.77},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26838.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25027.5},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23388.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11850.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11850.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8887.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46056.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6010.48,"maximum":30182.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19839.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18567.19},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19839.76},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17587.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16401.1},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15327.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8013.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8013.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6010.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30182.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":268.2,"10th_percentile":268.2,"90th_percentile":268.2,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":28056.97,"maximum":151814.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":99793.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":93392.37},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":99793.33},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88466.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82497.0},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77095.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37409.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37409.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28056.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151814.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12558.51,"maximum":66308.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43586.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40791.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43586.79},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38639.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36032.26},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33673.21},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16744.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16744.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12558.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66308.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6891.38,"maximum":35042.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23034.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21556.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23034.4},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20419.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19042.04},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17795.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9188.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9188.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6891.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35042.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9035.5,"maximum":46871.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30810.27},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28834.03},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30810.27},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27313.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25470.18},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23802.64},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12047.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12047.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9035.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46871.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9524.51,"maximum":49569.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32583.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30493.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32583.71},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28885.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26936.25},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25172.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12699.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12699.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9524.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49569.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10879.82,"maximum":57046.66,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37498.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35093.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37498.85},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33242.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30999.49},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28969.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14506.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14506.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10879.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57046.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6556.19,"maximum":33192.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21818.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20419.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21818.85},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19342.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18037.17},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16856.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8741.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8741.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6556.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33192.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9535.74,"maximum":49631.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32624.43},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30531.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32624.43},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28921.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26969.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25204.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12714.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12714.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9535.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49631.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14044.07,"maximum":74504.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48974.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":45832.99},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48974.31},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43415.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40486.01},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37835.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18725.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18725.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14044.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74504.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5433.32,"maximum":26997.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17746.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16608.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17746.65},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15732.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14670.77},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13710.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7244.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7244.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5433.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26997.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":7299.48,"10th_percentile":7299.48,"90th_percentile":7299.48,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":6343.0,"10th_percentile":6343.0,"90th_percentile":6343.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8958.02,"maximum":46443.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30529.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28571.07},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30529.28},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27064.17},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25237.9},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23585.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11944.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11944.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8958.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46443.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6552.26,"maximum":33171.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21804.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20406.0},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21804.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19329.75},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18025.39},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16845.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6552.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33171.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":21161.96,"maximum":113774.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":74787.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":69990.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":74787.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66299.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61825.62},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57777.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28215.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28215.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21161.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113774.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9980.96,"maximum":52087.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34239.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32042.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34239.06},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30352.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28304.69},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26451.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13307.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13307.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9980.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52087.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6253.58,"maximum":31523.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20721.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19392.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20721.39},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18369.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17129.93},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16008.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8338.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6253.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31523.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13660.05,"maximum":72385.48,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47581.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44529.63},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47581.62},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42181.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39334.7},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36759.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18213.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18213.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13660.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72385.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":3661.43,"maximum":17222.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11320.72},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10594.58},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11320.72},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10035.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9358.59},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8745.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4881.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4881.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3661.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17222.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5820.15,"maximum":29131.99,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19149.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17921.23},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19149.52},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16976.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15830.5},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14794.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5820.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29131.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14342.76,"maximum":76152.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50057.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46846.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50057.52},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44375.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41381.47},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38672.21},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19123.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19123.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14342.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76152.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9706.42,"maximum":50572.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33243.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31111.1},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33243.4},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29470.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27481.61},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25682.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12941.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12941.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9706.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50572.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5908.11,"10th_percentile":5908.11,"90th_percentile":5908.11,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10123.0,"maximum":52871.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34754.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32524.98},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34754.19},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30809.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28730.54},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26849.54},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13497.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13497.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10123.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52871.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5700.01,"maximum":28469.12,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18713.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17513.45},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18713.8},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16589.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15470.29},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14457.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7600.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7600.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5700.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28469.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":23701.9,"maximum":127787.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":83999.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":78611.4},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":83999.31},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74465.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69440.42},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64894.12},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31602.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31602.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23701.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127787.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20853.74,"maximum":112073.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":73670.17},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":68944.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":73670.17},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65308.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60901.54},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56914.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27804.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27804.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20853.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112073.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6671.85,"maximum":33830.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22238.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20811.87},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22238.28},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19714.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18383.91},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17180.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8895.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8895.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6671.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33830.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":26154.82,"maximum":141320.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":92895.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":86936.53},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":92895.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82351.32},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76794.32},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71766.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34873.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34873.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26154.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141320.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":33488.3,"maximum":181779.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":119490.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":111826.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":119490.56},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105928.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98780.28},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92313.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44651.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44651.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33488.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":181779.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":30480.12,"maximum":165183.48,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":108581.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":101616.5},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":108581.14},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96257.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89761.69},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83884.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40640.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40640.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30480.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":165183.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":64087.71,"maximum":350599.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":230462.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":215679.73},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":230462.09},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":204304.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":190518.04},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":178044.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85450.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85450.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64087.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":350599.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4554.68,"maximum":22150.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14560.15},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13626.23},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14560.15},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12907.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12036.56},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11248.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6072.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6072.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4554.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22150.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7919.36,"maximum":40713.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26762.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25045.89},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26762.5},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23724.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22123.98},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20675.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40713.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":11772.4,"10th_percentile":11772.4,"90th_percentile":11772.4,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3008.5,"10th_percentile":3008.5,"90th_percentile":3008.5,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6964.69,"10th_percentile":6964.69,"90th_percentile":6964.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":10661.35,"10th_percentile":10661.35,"90th_percentile":10661.35,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":11865.69,"10th_percentile":11865.69,"90th_percentile":11865.69},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":21648.37,"10th_percentile":21648.37,"90th_percentile":21648.37},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":26826.86,"10th_percentile":26826.86,"90th_percentile":26826.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4955.54,"maximum":24361.84,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16013.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14986.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16013.93},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14196.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13238.37},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12371.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6607.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4955.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24361.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9313.41,"maximum":48404.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31818.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29777.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31818.13},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28206.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26303.37},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24581.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12417.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9313.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48404.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":14323.12,"10th_percentile":14323.12,"90th_percentile":14323.12,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":12683.9,"10th_percentile":12683.9,"90th_percentile":12683.9,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":14710.5,"maximum":78180.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51391.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48094.82},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51391.16},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45558.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42483.97},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39702.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14710.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78180.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4684.36,"maximum":22865.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15030.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14066.4},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15030.49},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13324.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12425.38},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11611.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6245.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6245.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4684.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22865.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7289.99,"maximum":37241.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24480.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22909.83},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24480.03},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21701.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20237.11},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18912.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9719.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9719.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37241.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8923.21,"maximum":46251.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30403.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28452.93},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30403.05},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26952.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25133.54},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23488.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11897.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8923.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46251.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6630.86,"maximum":33604.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22089.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20672.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22089.65},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19582.45},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18261.04},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17065.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8841.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8841.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6630.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33604.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":11413.74,"maximum":59992.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39435.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36905.72},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39435.18},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34959.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32600.22},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30465.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15218.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15218.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11413.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59992.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6283.34,"maximum":31687.43,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20829.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19493.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20829.3},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18465.15},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17219.14},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16091.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8377.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8377.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6283.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31687.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5906.06,"maximum":29605.91,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19461.04},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18212.77},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19461.04},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17252.19},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16088.03},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15034.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7874.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7874.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5906.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29605.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9546.97,"maximum":49693.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32665.15},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30569.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32665.15},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28957.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27003.58},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25235.64},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12729.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12729.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9546.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49693.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":13724.74,"10th_percentile":13724.74,"90th_percentile":13724.74,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6212.03,"maximum":31294.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20570.72},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19251.27},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20570.72},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18235.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17005.37},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15892.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6212.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31294.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":6316.03,"10th_percentile":6316.03,"90th_percentile":6316.03,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":7714.48,"10th_percentile":7714.48,"90th_percentile":7714.48,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":26004.06,"10th_percentile":26004.06,"90th_percentile":26004.06,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7813.82,"maximum":40131.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26379.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24687.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26379.71},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23385.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21807.54},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20379.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10418.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10418.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40131.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":22218.02,"maximum":119600.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":78617.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":73575.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":78617.89},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69694.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64991.72},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60736.68},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29624.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29624.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22218.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119600.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12504.05,"maximum":66007.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43389.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40606.21},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43389.29},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38464.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35868.99},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33520.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16672.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16672.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66007.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":22502.67,"maximum":121171.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":79650.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":74541.25},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":79650.2},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70609.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65845.1},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61534.19},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30003.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30003.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121171.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":33831.34,"maximum":183672.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":120734.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":112990.43},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":120734.62},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107031.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99808.71},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93274.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45108.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45108.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33831.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183672.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":26573.65,"maximum":143631.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":94413.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":88358.04},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":94413.96},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83697.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78049.98},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72940.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35431.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35431.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26573.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143631.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9518.9,"maximum":49538.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32563.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30474.66},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32563.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28867.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26919.42},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25156.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12691.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12691.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9518.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49538.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [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":22145.68,"10th_percentile":22145.68,"90th_percentile":22145.68,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":16822.62,"maximum":89833.7,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59050.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":55263.31},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":59050.97},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52348.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48816.17},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45620.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22430.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22430.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16822.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89833.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":20541.58,"maximum":110351.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72538.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":67885.34},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72538.1},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64304.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59965.68},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56039.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27388.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27388.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20541.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110351.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8397.14,"maximum":43349.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28495.22},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26667.47},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28495.22},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25260.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23556.38},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22014.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8397.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43349.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":32918.44,"maximum":178635.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":117423.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":109892.09},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":117423.92},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104096.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97071.83},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90716.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43891.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43891.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32918.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178635.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10611.45,"maximum":55566.05,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36525.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34182.76},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36525.6},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32379.9},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30194.92},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28218.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14148.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14148.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10611.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55566.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8606.0,"maximum":44501.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29252.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27376.32},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29252.65},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25932.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24182.53},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22599.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11474.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11474.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8606.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44501.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6805.42,"10th_percentile":6805.42,"90th_percentile":6805.42,"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":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4853.36,"maximum":23798.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15643.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14639.96},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15643.36},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13867.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12932.03},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12085.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6471.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6471.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4853.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23798.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10814.13,"maximum":56684.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37260.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34870.65},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37260.63},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33031.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30802.56},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28785.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10814.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56684.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18063.4,"maximum":96679.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":63550.75},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":59474.47},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":63550.75},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56337.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52536.04},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49096.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18063.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96679.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":24129.16,"maximum":130144.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":85548.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":80061.49},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":85548.78},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75838.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70721.33},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66091.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32172.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32172.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24129.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130144.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":4976.87,"maximum":24479.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16091.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15059.17},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16091.3},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14264.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13302.33},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12431.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24479.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9828.25,"maximum":51245.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33685.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31524.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33685.24},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29861.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27846.86},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26023.71},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13104.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13104.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9828.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51245.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":14870.73,"10th_percentile":14870.73,"90th_percentile":14870.73,"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":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6713.96,"maximum":34063.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22390.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20954.78},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22390.99},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19849.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18510.15},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17298.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6713.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34063.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6955.38,"maximum":35395.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23266.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21774.15},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23266.51},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20625.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19233.93},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17974.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9273.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9273.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35395.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":12498.44,"maximum":65976.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43368.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40587.15},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43368.93},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38446.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35852.16},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33504.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16664.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16664.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65976.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10841.08,"maximum":56832.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37358.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34962.11},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37358.36},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33118.14},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30883.35},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28861.4},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14454.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14454.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10841.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56832.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":10658.05,"maximum":55823.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36694.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34340.92},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36694.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32529.71},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30334.63},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28348.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14210.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14210.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10658.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55823.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"1 through 10","median_amount":2839.0,"10th_percentile":2839.0,"90th_percentile":2839.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1643.82,"10th_percentile":1643.82,"90th_percentile":1643.82,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6156.45,"maximum":30987.39,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20369.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19062.62},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20369.14},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18057.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16838.73},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15736.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8208.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8208.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6156.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30987.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":6598.87,"maximum":33428.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21973.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20564.16},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21973.59},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19479.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18165.09},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16975.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8798.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8798.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33428.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":9103.43,"maximum":47246.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31056.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29064.59},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31056.63},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27531.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25673.85},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23992.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47246.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month 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":13752.12,"10th_percentile":13752.12,"90th_percentile":13762.29,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 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":12071.69,"10th_percentile":12071.69,"90th_percentile":12071.69,"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":13108.16,"maximum":69340.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45580.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42656.52},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45580.13},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40406.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37680.12},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35213.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17477.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17477.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13108.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69340.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":18281.24,"maximum":97881.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64340.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":60213.8},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64340.76},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57038.0},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53189.12},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49706.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24374.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24374.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18281.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97881.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":27512.93,"maximum":148813.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":97820.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":91545.94},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":97820.35},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86717.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80865.98},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75571.64},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36683.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36683.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27512.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":148813.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5321.03,"maximum":26378.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17339.43},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16227.24},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17339.43},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15371.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14334.13},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13395.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7094.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7094.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5321.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26378.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":8945.67,"maximum":46375.77,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30484.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28529.15},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30484.49},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27024.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25200.87},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23550.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11927.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11927.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8945.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46375.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":5422.1,"maximum":26935.86,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17705.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16570.23},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17705.93},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15696.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14637.11},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13678.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7229.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7229.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5422.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26935.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":7568.47,"maximum":38777.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25489.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23854.95},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25489.94},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22596.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21071.98},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19692.39},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10091.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10091.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7568.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38777.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":12067.0,"10th_percentile":12067.0,"90th_percentile":12067.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1039.93,"10th_percentile":1039.93,"90th_percentile":1039.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":121.94,"10th_percentile":121.94,"90th_percentile":121.94,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2005.51,"10th_percentile":2005.51,"90th_percentile":2005.51,"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":7907.59,"10th_percentile":7907.59,"90th_percentile":7907.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":275.56,"10th_percentile":275.56,"90th_percentile":275.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":121.94,"10th_percentile":121.94,"90th_percentile":121.94,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":355.28,"10th_percentile":355.28,"90th_percentile":355.28,"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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":104.4,"10th_percentile":104.4,"90th_percentile":104.4,"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":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":342.0,"10th_percentile":342.0,"90th_percentile":342.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":264.64,"10th_percentile":264.64,"90th_percentile":264.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":83.61,"10th_percentile":83.61,"90th_percentile":127.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"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":46.94,"10th_percentile":46.94,"90th_percentile":46.94,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":46.95,"10th_percentile":46.95,"90th_percentile":46.95,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":85.39,"10th_percentile":85.39,"90th_percentile":85.39,"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":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"92","median_amount":342.0,"10th_percentile":66.4,"90th_percentile":342.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"45","median_amount":317.0,"10th_percentile":93.62,"90th_percentile":334.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"20","median_amount":84.54,"10th_percentile":51.46,"90th_percentile":147.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":75.36,"10th_percentile":68.43,"90th_percentile":153.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"189","median_amount":76.76,"10th_percentile":51.46,"90th_percentile":219.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":150.72,"10th_percentile":57.63,"90th_percentile":152.65,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"39","median_amount":75.91,"10th_percentile":46.94,"90th_percentile":131.82,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":"68","median_amount":76.76,"10th_percentile":51.46,"90th_percentile":177.88,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":80.1,"10th_percentile":69.46,"90th_percentile":152.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":119.88,"10th_percentile":119.88,"90th_percentile":149.85,"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":"11","median_amount":409.82,"10th_percentile":201.28,"90th_percentile":906.58},{"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":348.0,"10th_percentile":348.0,"90th_percentile":348.0},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":872.69,"10th_percentile":872.69,"90th_percentile":872.69},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":1019.0,"10th_percentile":1019.0,"90th_percentile":1019.0},{"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"91","median_amount":76.76,"10th_percentile":51.46,"90th_percentile":154.68,"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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"30","median_amount":313.5,"10th_percentile":150.0,"90th_percentile":849.98},{"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":"34","median_amount":278.4,"10th_percentile":145.91,"90th_percentile":425.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":325.28,"10th_percentile":180.23,"90th_percentile":657.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"50","median_amount":539.73,"10th_percentile":313.2,"90th_percentile":1582.2,"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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"432","median_amount":1046.0,"10th_percentile":509.2,"90th_percentile":1273.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"253","median_amount":881.6,"10th_percentile":254.0,"90th_percentile":1054.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":996.9,"10th_percentile":636.5,"90th_percentile":1273.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"53","median_amount":104.39,"10th_percentile":57.63,"90th_percentile":227.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"1 through 10","median_amount":2350.56,"10th_percentile":2350.56,"90th_percentile":2350.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm] [All Other OP (%BC): 7.51]","count":"14","median_amount":137.14,"10th_percentile":66.95,"90th_percentile":262.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"555","median_amount":100.47,"10th_percentile":63.93,"90th_percentile":248.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"136","median_amount":264.5,"10th_percentile":139.5,"90th_percentile":476.98,"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":"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":98.1,"10th_percentile":65.39,"90th_percentile":248.11,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":"182","median_amount":93.62,"10th_percentile":57.63,"90th_percentile":236.25,"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 ($): FEE SCHEDULE]","count":"38","median_amount":240.67,"10th_percentile":154.2,"90th_percentile":529.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":210.38,"10th_percentile":207.27,"90th_percentile":372.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"227","median_amount":104.39,"10th_percentile":65.69,"90th_percentile":247.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"110","median_amount":893.62,"10th_percentile":364.5,"90th_percentile":1823.04},{"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":"172","median_amount":672.3,"10th_percentile":267.35,"90th_percentile":2009.6,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":507.01,"10th_percentile":507.01,"90th_percentile":507.01},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"38","median_amount":785.47,"10th_percentile":324.72,"90th_percentile":1869.87,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"199","median_amount":1157.4,"10th_percentile":680.4,"90th_percentile":2350.82,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1634.07,"10th_percentile":1414.84,"90th_percentile":2039.52,"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."}]}]},{"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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"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":"27","median_amount":175.52,"10th_percentile":73.57,"90th_percentile":492.01,"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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":133.17,"10th_percentile":77.53,"90th_percentile":616.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"223","median_amount":219.39,"10th_percentile":73.57,"90th_percentile":395.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"114","median_amount":668.36,"10th_percentile":404.39,"90th_percentile":986.68,"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":"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":"48","median_amount":243.05,"10th_percentile":83.6,"90th_percentile":594.19,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":"78","median_amount":236.64,"10th_percentile":73.57,"90th_percentile":481.45,"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":"26","median_amount":476.93,"10th_percentile":304.19,"90th_percentile":916.33,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":92.2,"10th_percentile":92.2,"90th_percentile":92.2,"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":"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":"53","median_amount":4775.47,"10th_percentile":1825.92,"90th_percentile":8349.89},{"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":220.0,"10th_percentile":220.0,"90th_percentile":1274.04},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"11","median_amount":3853.37,"10th_percentile":692.42,"90th_percentile":8652.7},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":1852.34,"10th_percentile":1852.34,"90th_percentile":1852.34},{"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":5005.88,"10th_percentile":5005.88,"90th_percentile":9386.48},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"100","median_amount":234.27,"10th_percentile":73.57,"90th_percentile":488.32,"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":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"87","median_amount":2840.37,"10th_percentile":1521.33,"90th_percentile":7282.54},{"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":"149","median_amount":2425.52,"10th_percentile":496.17,"90th_percentile":6372.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":757.04,"10th_percentile":757.04,"90th_percentile":757.04},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"32","median_amount":1359.14,"10th_percentile":300.0,"90th_percentile":5628.92,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"65","median_amount":2374.08,"10th_percentile":1805.72,"90th_percentile":10573.47,"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":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"132","median_amount":6286.8,"10th_percentile":4003.76,"90th_percentile":7349.97,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, 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":515.39,"10th_percentile":369.35,"90th_percentile":986.35,"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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":507.7,"10th_percentile":354.38,"90th_percentile":672.45,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"66","median_amount":471.17,"10th_percentile":229.28,"90th_percentile":640.03,"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":"100","median_amount":1005.1,"10th_percentile":663.46,"90th_percentile":2064.41,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":520.12,"10th_percentile":199.17,"90th_percentile":811.63,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4090.17,"10th_percentile":4090.17,"90th_percentile":4090.17},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":"27","median_amount":464.38,"10th_percentile":159.84,"90th_percentile":921.07,"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":"11","median_amount":1037.35,"10th_percentile":748.59,"90th_percentile":2397.61,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1321.08,"10th_percentile":1321.08,"90th_percentile":1321.08,"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":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":842.23,"10th_percentile":659.63,"90th_percentile":1161.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"19","median_amount":10127.28,"10th_percentile":5566.36,"90th_percentile":14220.33},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":683.55,"10th_percentile":683.55,"90th_percentile":683.55},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":"29","median_amount":435.1,"10th_percentile":184.18,"90th_percentile":880.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"32","median_amount":4781.25,"10th_percentile":3688.92,"90th_percentile":14176.14},{"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":"70","median_amount":5120.6,"10th_percentile":1260.09,"90th_percentile":11931.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"18","median_amount":3156.58,"10th_percentile":1248.45,"90th_percentile":8545.4,"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":"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":9359.47,"10th_percentile":8438.14,"90th_percentile":20490.08,"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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"1 through 10","median_amount":17536.4,"10th_percentile":17536.4,"90th_percentile":17536.4,"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":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":10154.66,"10th_percentile":10154.66,"90th_percentile":10154.66,"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."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"14","median_amount":8944.3,"10th_percentile":5194.05,"90th_percentile":10539.01,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"14","median_amount":10457.0,"10th_percentile":5186.27,"90th_percentile":11020.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":883.24,"10th_percentile":365.84,"90th_percentile":1383.4,"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":"22","median_amount":1526.29,"10th_percentile":1082.5,"90th_percentile":2142.59,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":402.2,"10th_percentile":328.88,"90th_percentile":1020.7,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":511.07,"10th_percentile":511.07,"90th_percentile":1559.9,"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":2387.59,"10th_percentile":2387.59,"90th_percentile":2387.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":880.56,"10th_percentile":880.56,"90th_percentile":880.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1244.71,"10th_percentile":1244.71,"90th_percentile":1244.71,"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":10014.14,"10th_percentile":7659.21,"90th_percentile":26620.7},{"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":91.0,"count":"1 through 10","median_amount":18264.88,"10th_percentile":18264.88,"90th_percentile":18264.88},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":470.83,"10th_percentile":447.97,"90th_percentile":1659.23,"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":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":13845.94,"10th_percentile":6889.5,"90th_percentile":44422.16},{"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":9218.84,"10th_percentile":5704.0,"90th_percentile":20381.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":4791.15,"10th_percentile":4677.01,"90th_percentile":4822.4,"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":"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":19987.33,"10th_percentile":19987.33,"90th_percentile":19987.33,"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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma Response with Critical Care","code_information":[{"code":"5045","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":10539.0,"10th_percentile":10539.0,"90th_percentile":10750.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":7457.0,"10th_percentile":7457.0,"90th_percentile":7457.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":694.19,"10th_percentile":694.19,"90th_percentile":694.19,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":140.33,"10th_percentile":140.33,"90th_percentile":140.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":17483.25,"10th_percentile":17483.25,"90th_percentile":17483.25},{"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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":27025.8,"10th_percentile":27025.8,"90th_percentile":27025.8,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"43","median_amount":74.15,"10th_percentile":38.85,"90th_percentile":1273.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"11","median_amount":85.39,"10th_percentile":38.18,"90th_percentile":1046.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"1 through 10","median_amount":75.0,"10th_percentile":75.0,"90th_percentile":75.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":157.92,"10th_percentile":157.92,"90th_percentile":303.6,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":215.37,"10th_percentile":215.37,"90th_percentile":261.59,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":160.11,"10th_percentile":160.11,"90th_percentile":345.28,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":160.11,"10th_percentile":160.11,"90th_percentile":160.11,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":209.6,"10th_percentile":209.6,"90th_percentile":209.6,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":626.88,"10th_percentile":521.18,"90th_percentile":748.8},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":165.57,"10th_percentile":165.57,"90th_percentile":165.57,"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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":488.43,"10th_percentile":457.09,"90th_percentile":583.95},{"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":645.29,"10th_percentile":516.92,"90th_percentile":1280.96,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":239.83,"10th_percentile":100.0,"90th_percentile":909.26,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"58","median_amount":1122.4,"10th_percentile":643.05,"90th_percentile":1783.24,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":607.55,"10th_percentile":70.6,"90th_percentile":1273.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":1046.0,"10th_percentile":1046.0,"90th_percentile":3036.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":147.5,"10th_percentile":147.5,"90th_percentile":147.5,"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":517.55,"10th_percentile":517.55,"90th_percentile":517.55,"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":"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":157.71,"10th_percentile":157.71,"90th_percentile":157.71,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":1338.12,"10th_percentile":1338.12,"90th_percentile":1338.12,"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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":894.72,"10th_percentile":894.72,"90th_percentile":894.72},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":160.11,"10th_percentile":160.11,"90th_percentile":160.11,"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":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":1538.18,"10th_percentile":1538.18,"90th_percentile":1538.18},{"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":1808.46,"10th_percentile":1808.46,"90th_percentile":2804.58,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1516.75,"10th_percentile":1516.75,"90th_percentile":1516.75,"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":"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":1490.41,"10th_percentile":838.8,"90th_percentile":1535.76,"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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":196.93,"10th_percentile":196.93,"90th_percentile":305.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":71.45,"10th_percentile":71.45,"90th_percentile":71.45,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":606.58,"10th_percentile":606.58,"90th_percentile":606.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":3238.31,"10th_percentile":3238.31,"90th_percentile":3238.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":3459.1,"10th_percentile":1977.4,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":3329.0,"10th_percentile":3329.0,"90th_percentile":3329.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":674.77,"10th_percentile":674.77,"90th_percentile":674.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":5358.85,"10th_percentile":3575.16,"90th_percentile":5928.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":4030.68,"10th_percentile":3123.82,"90th_percentile":4136.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":1596.76,"10th_percentile":1256.05,"90th_percentile":1656.43,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":578.51,"10th_percentile":578.51,"90th_percentile":578.51,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":588.06,"10th_percentile":588.06,"90th_percentile":588.06,"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":1271.8,"10th_percentile":1271.8,"90th_percentile":1271.8,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":4922.22,"10th_percentile":4922.22,"90th_percentile":4922.22},{"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":3687.94,"10th_percentile":3687.94,"90th_percentile":7962.79,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6179.92,"10th_percentile":6179.92,"90th_percentile":6179.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":237.1,"10th_percentile":237.1,"90th_percentile":238.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":4528.35,"10th_percentile":4528.35,"90th_percentile":4528.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1791.6,"10th_percentile":1172.51,"90th_percentile":2329.08,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":528.0,"10th_percentile":528.0,"90th_percentile":528.0},{"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":"1 through 10","median_amount":901.56,"10th_percentile":901.56,"90th_percentile":901.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":540.06,"10th_percentile":50.0,"90th_percentile":7350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":5631.0,"10th_percentile":5631.0,"90th_percentile":5631.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":329.15,"10th_percentile":329.15,"90th_percentile":329.15,"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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":908.59,"10th_percentile":908.59,"90th_percentile":908.59},{"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":"1 through 10","median_amount":3257.47,"10th_percentile":1117.13,"90th_percentile":3508.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":4791.1,"10th_percentile":1101.98,"90th_percentile":6322.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":5129.0,"10th_percentile":5129.0,"90th_percentile":5129.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":570.79,"10th_percentile":570.79,"90th_percentile":570.79,"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":"1 through 10","median_amount":1516.88,"10th_percentile":1516.88,"90th_percentile":1523.38,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1339.99,"10th_percentile":1339.99,"90th_percentile":1339.99,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":1211.51,"10th_percentile":1211.51,"90th_percentile":1211.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":1211.51,"10th_percentile":1211.51,"90th_percentile":1211.51,"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":329.15,"10th_percentile":329.15,"90th_percentile":329.15,"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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":3536.1,"10th_percentile":3536.1,"90th_percentile":3536.1,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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":5478.58,"10th_percentile":5478.58,"90th_percentile":5478.58,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":11925.56,"10th_percentile":11285.7,"90th_percentile":15300.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":10828.49,"10th_percentile":10382.79,"90th_percentile":12349.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":2258.26,"10th_percentile":2258.26,"90th_percentile":2258.26,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3079.21,"10th_percentile":2946.29,"90th_percentile":3529.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2351.43,"10th_percentile":2351.43,"90th_percentile":2351.43,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":12406.13,"10th_percentile":10473.14,"90th_percentile":16475.78},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":5843.02,"10th_percentile":5843.02,"90th_percentile":5843.02},{"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":8290.43,"10th_percentile":7147.75,"90th_percentile":13680.3,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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":9244.54,"10th_percentile":5921.88,"90th_percentile":16123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":20328.4,"10th_percentile":20328.4,"90th_percentile":26072.43,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":25918.05,"10th_percentile":24392.19,"90th_percentile":27058.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":2755.86,"10th_percentile":2755.86,"90th_percentile":2755.86,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6367.75,"10th_percentile":6367.75,"90th_percentile":6367.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":17973.76,"10th_percentile":17973.76,"90th_percentile":17973.76,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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":24529.25,"10th_percentile":24529.25,"90th_percentile":24529.25,"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":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":32824.42,"10th_percentile":31348.0,"90th_percentile":40262.97,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":30418.5,"10th_percentile":18405.52,"90th_percentile":50998.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":12149.91,"10th_percentile":11923.1,"90th_percentile":12373.1,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":4049.14,"10th_percentile":4049.14,"90th_percentile":4049.14,"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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":31276.28,"10th_percentile":27617.65,"90th_percentile":31440.33,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":26285.5,"10th_percentile":26285.5,"90th_percentile":26285.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":37608.55,"10th_percentile":37608.55,"90th_percentile":43368.18,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":66.28,"10th_percentile":66.28,"90th_percentile":66.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":5928.0,"10th_percentile":5928.0,"90th_percentile":5928.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":2448.55,"10th_percentile":2448.55,"90th_percentile":2448.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":8955.69,"10th_percentile":8955.69,"90th_percentile":8955.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":5988.8,"10th_percentile":5988.8,"90th_percentile":5988.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":1381.02,"10th_percentile":1381.02,"90th_percentile":1381.02,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":924.27,"10th_percentile":924.27,"90th_percentile":924.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":5458.95,"10th_percentile":5458.95,"90th_percentile":5458.95,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":31518.57,"10th_percentile":31518.57,"90th_percentile":31518.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":4401.0,"10th_percentile":4401.0,"90th_percentile":4401.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3934.94,"10th_percentile":3934.94,"90th_percentile":3934.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":51408.52,"10th_percentile":51408.52,"90th_percentile":51408.52,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":11001.81,"10th_percentile":11001.81,"90th_percentile":11001.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":7984.95,"10th_percentile":7984.95,"90th_percentile":7984.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":2986.32,"10th_percentile":2855.82,"90th_percentile":2987.32,"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":"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":1696.74,"10th_percentile":1696.74,"90th_percentile":1696.74,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":929.76,"10th_percentile":929.76,"90th_percentile":929.76,"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":4979.25,"10th_percentile":4979.25,"90th_percentile":4979.25,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":3109.85,"10th_percentile":3109.85,"90th_percentile":3109.85,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":2629.64,"10th_percentile":1714.01,"90th_percentile":3768.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1310.34,"10th_percentile":1310.34,"90th_percentile":1310.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":4765.18,"10th_percentile":4765.18,"90th_percentile":4765.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"11","median_amount":4484.0,"10th_percentile":3520.8,"90th_percentile":6726.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":4520.13,"10th_percentile":4401.0,"90th_percentile":5631.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":860.32,"10th_percentile":430.16,"90th_percentile":868.69,"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":"23","median_amount":896.16,"10th_percentile":887.16,"90th_percentile":1326.52,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":441.23,"10th_percentile":441.23,"90th_percentile":441.23,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":440.93,"10th_percentile":430.16,"90th_percentile":868.09,"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":1063.41,"10th_percentile":658.53,"90th_percentile":1137.2,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":989.11,"10th_percentile":709.74,"90th_percentile":1064.61,"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":"1 through 10","median_amount":4543.33,"10th_percentile":4543.33,"90th_percentile":4543.33},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":9941.79,"10th_percentile":9941.79,"90th_percentile":9941.79},{"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":3337.87,"10th_percentile":911.8,"90th_percentile":3767.11,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":4278.13,"10th_percentile":4278.13,"90th_percentile":4278.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":4224.35,"10th_percentile":4224.35,"90th_percentile":4224.35,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":4586.07,"10th_percentile":4586.07,"90th_percentile":4855.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":1804.03,"10th_percentile":1734.91,"90th_percentile":1804.03,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":934.03,"10th_percentile":934.03,"90th_percentile":934.03,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":3512.13,"10th_percentile":3512.13,"90th_percentile":3512.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":3966.53,"10th_percentile":3966.53,"90th_percentile":3966.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"37","median_amount":4484.0,"10th_percentile":4401.0,"90th_percentile":4680.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"42","median_amount":4401.0,"10th_percentile":4361.15,"90th_percentile":4638.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":427.46,"10th_percentile":421.5,"90th_percentile":435.23,"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":"21","median_amount":862.7,"10th_percentile":829.94,"90th_percentile":870.7,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":427.37,"10th_percentile":427.37,"90th_percentile":427.37,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":427.46,"10th_percentile":427.46,"90th_percentile":427.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":699.67,"10th_percentile":699.67,"90th_percentile":699.67,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":554.75,"10th_percentile":554.75,"90th_percentile":554.75,"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":"1 through 10","median_amount":4594.65,"10th_percentile":4586.24,"90th_percentile":4710.58},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"25","median_amount":3511.91,"10th_percentile":3437.33,"90th_percentile":3900.06,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":4407.74,"10th_percentile":4407.74,"90th_percentile":4407.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":7784.54,"10th_percentile":7784.54,"90th_percentile":7784.54,"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 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"49","median_amount":5134.81,"10th_percentile":4633.57,"90th_percentile":7592.1,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"49","median_amount":4867.0,"10th_percentile":4777.3,"90th_percentile":6107.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":4966.1,"10th_percentile":4966.1,"90th_percentile":5498.12,"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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":854.92,"10th_percentile":427.46,"90th_percentile":868.69,"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":"64","median_amount":1118.29,"10th_percentile":1078.59,"90th_percentile":1675.36,"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":"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":987.62,"10th_percentile":987.62,"90th_percentile":987.62,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":427.46,"10th_percentile":427.46,"90th_percentile":472.16,"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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":892.56,"10th_percentile":892.56,"90th_percentile":892.56,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":892.56,"10th_percentile":892.56,"90th_percentile":1338.84,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":4695.48,"10th_percentile":4603.27,"90th_percentile":4846.01},{"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":91.0,"count":"1 through 10","median_amount":4439.24,"10th_percentile":4439.24,"90th_percentile":4439.24},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"33","median_amount":3796.1,"10th_percentile":2846.36,"90th_percentile":4368.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":5193.96,"10th_percentile":4449.14,"90th_percentile":9254.79,"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":"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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":1380.11,"10th_percentile":1380.11,"90th_percentile":1380.11,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":27599.22,"10th_percentile":27599.22,"90th_percentile":27599.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":12918.01,"10th_percentile":12918.01,"90th_percentile":12918.01,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":12189.12,"10th_percentile":12189.12,"90th_percentile":12189.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":16881.09,"10th_percentile":11219.3,"90th_percentile":19630.5,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"15","median_amount":16059.62,"10th_percentile":13781.0,"90th_percentile":17684.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":2191.13,"10th_percentile":2060.0,"90th_percentile":2532.33,"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":5528.75,"10th_percentile":5246.59,"90th_percentile":5529.75,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3035.42,"10th_percentile":3035.42,"90th_percentile":3035.42,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":2192.34,"10th_percentile":2188.45,"90th_percentile":2207.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4416.61,"10th_percentile":4416.61,"90th_percentile":4416.61,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":11974.38,"10th_percentile":10295.81,"90th_percentile":19501.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":14696.63,"10th_percentile":14696.63,"90th_percentile":14696.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":11967.67,"10th_percentile":11562.13,"90th_percentile":13114.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":5928.0,"10th_percentile":5928.0,"90th_percentile":5928.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1946.4,"10th_percentile":1946.4,"90th_percentile":1946.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":9489.61,"10th_percentile":9489.61,"90th_percentile":11257.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3271.59,"10th_percentile":3172.69,"90th_percentile":3682.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2610.87,"10th_percentile":2610.87,"90th_percentile":2610.87,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":6188.54,"10th_percentile":6188.54,"90th_percentile":6188.54},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4819.37,"10th_percentile":4819.37,"90th_percentile":4819.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"17","median_amount":419.2,"10th_percentile":404.04,"90th_percentile":688.92,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"16","median_amount":419.2,"10th_percentile":105.26,"90th_percentile":880.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":97.15,"10th_percentile":97.15,"90th_percentile":97.15,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":84.57,"10th_percentile":84.57,"90th_percentile":432.78,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"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":534.66,"10th_percentile":534.66,"90th_percentile":534.66,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":230.42,"10th_percentile":230.42,"90th_percentile":230.42,"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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":7609.49,"10th_percentile":7609.49,"90th_percentile":7609.49},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":175.14,"10th_percentile":175.14,"90th_percentile":175.14,"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":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"14","median_amount":544.99,"10th_percentile":492.66,"90th_percentile":1364.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":1046.0,"10th_percentile":1046.0,"90th_percentile":1046.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":763.91,"10th_percentile":763.91,"90th_percentile":763.91},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":5928.0,"10th_percentile":5928.0,"90th_percentile":5928.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":5833.53,"10th_percentile":5833.53,"90th_percentile":5833.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2567.63,"10th_percentile":2567.63,"90th_percentile":2567.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":3608.07,"10th_percentile":3608.07,"90th_percentile":3608.07,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":11848.0,"10th_percentile":11848.0,"90th_percentile":11848.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":5473.07,"10th_percentile":5473.07,"90th_percentile":5473.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":4531.61,"10th_percentile":4531.61,"90th_percentile":4531.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":565.26,"10th_percentile":565.26,"90th_percentile":565.26,"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":1855.61,"10th_percentile":1760.3,"90th_percentile":1856.81,"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":"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":582.77,"10th_percentile":582.77,"90th_percentile":582.77,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":586.2,"10th_percentile":586.2,"90th_percentile":586.2,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":4415.25,"10th_percentile":4415.25,"90th_percentile":4415.25},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":3800.52,"10th_percentile":3800.52,"90th_percentile":5053.74,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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":4491.57,"10th_percentile":4491.57,"90th_percentile":4502.3,"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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":752.79,"10th_percentile":752.79,"90th_percentile":991.82,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":784.5,"10th_percentile":784.5,"90th_percentile":836.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":229.28,"10th_percentile":221.45,"90th_percentile":229.28,"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":"1 through 10","median_amount":294.38,"10th_percentile":285.02,"90th_percentile":434.12,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":106.12,"10th_percentile":106.12,"90th_percentile":106.12,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":106.14,"10th_percentile":103.84,"90th_percentile":229.28,"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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":171.65,"10th_percentile":171.65,"90th_percentile":171.65},{"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":91.0,"count":"1 through 10","median_amount":801.5,"10th_percentile":801.5,"90th_percentile":801.5},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":229.28,"10th_percentile":229.28,"90th_percentile":229.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":1075.72,"10th_percentile":1075.72,"90th_percentile":1445.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1289.04,"10th_percentile":1289.04,"90th_percentile":1289.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":697.88,"10th_percentile":697.88,"90th_percentile":697.88,"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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":3224.7,"10th_percentile":298.3,"90th_percentile":5556.22,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":4504.8,"10th_percentile":4504.8,"90th_percentile":4504.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":228.63,"10th_percentile":228.63,"90th_percentile":228.63,"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":"1 through 10","median_amount":663.1,"10th_percentile":223.71,"90th_percentile":896.92,"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":"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":1011.2,"10th_percentile":1011.2,"90th_percentile":1011.2,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":2429.48,"10th_percentile":2429.48,"90th_percentile":6141.47,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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":1739.53,"10th_percentile":1739.53,"90th_percentile":1739.53,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":4144.8,"10th_percentile":3780.0,"90th_percentile":6320.9,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":326.67,"10th_percentile":326.67,"90th_percentile":344.57,"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":"13","median_amount":850.44,"10th_percentile":836.16,"90th_percentile":851.44,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":653.34,"10th_percentile":653.34,"90th_percentile":653.34,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":2596.05,"10th_percentile":2596.05,"90th_percentile":2596.05,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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":4317.27,"10th_percentile":4317.27,"90th_percentile":4317.27,"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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laser Eye Procedures","code_information":[{"code":"5481","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":916.92,"10th_percentile":916.92,"90th_percentile":916.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Intraocular Procedures","code_information":[{"code":"5491","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":6107.35,"10th_percentile":6081.45,"90th_percentile":7882.35,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":3598.0,"10th_percentile":3598.0,"90th_percentile":5414.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":747.3,"10th_percentile":747.3,"90th_percentile":747.3,"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":"0","additional_payer_notes":"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":"47","median_amount":2166.14,"10th_percentile":1766.14,"90th_percentile":2167.14,"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":"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":732.05,"10th_percentile":732.05,"90th_percentile":732.05,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":740.4,"10th_percentile":739.9,"90th_percentile":743.2,"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":1726.51,"10th_percentile":1692.91,"90th_percentile":1726.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":1726.51,"10th_percentile":1726.51,"90th_percentile":1726.51,"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":"1 through 10","median_amount":7931.49,"10th_percentile":7931.49,"90th_percentile":10281.28},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"12","median_amount":7213.74,"10th_percentile":6487.58,"90th_percentile":8771.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":11768.74,"10th_percentile":11768.74,"90th_percentile":11768.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Intraocular Procedures","code_information":[{"code":"5492","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":20812.96,"10th_percentile":20812.96,"90th_percentile":20812.96,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3815.62,"10th_percentile":3814.62,"90th_percentile":3815.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3045.3,"10th_percentile":3045.3,"90th_percentile":3045.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":14858.39,"10th_percentile":14858.39,"90th_percentile":14858.39},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"268","median_amount":275.56,"10th_percentile":207.34,"90th_percentile":1189.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"146","median_amount":270.12,"10th_percentile":181.14,"90th_percentile":1346.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":2903.92,"10th_percentile":2903.92,"90th_percentile":2903.92,"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":"1 through 10","median_amount":80.06,"10th_percentile":80.06,"90th_percentile":80.06,"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":"Centivo","plan_name":"Broad(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":27.04,"10th_percentile":24.04,"90th_percentile":27.04,"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":"101","median_amount":27.48,"10th_percentile":23.57,"90th_percentile":278.65,"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":"180","median_amount":83.92,"10th_percentile":53.92,"90th_percentile":245.35,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":72.53,"10th_percentile":23.79,"90th_percentile":191.98,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":"26","median_amount":71.99,"10th_percentile":23.8,"90th_percentile":136.02,"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":"22","median_amount":76.51,"10th_percentile":66.01,"90th_percentile":553.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":66.66,"10th_percentile":66.66,"90th_percentile":66.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":66.66,"10th_percentile":66.66,"90th_percentile":389.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"35","median_amount":604.48,"10th_percentile":348.92,"90th_percentile":1510.42},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":925.52,"10th_percentile":925.52,"90th_percentile":925.52},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":"12","median_amount":187.99,"10th_percentile":84.23,"90th_percentile":278.65,"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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"20","median_amount":626.25,"10th_percentile":384.75,"90th_percentile":2615.67},{"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":"124","median_amount":475.2,"10th_percentile":181.19,"90th_percentile":990.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":496.72,"10th_percentile":496.72,"90th_percentile":496.72},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"19","median_amount":612.45,"10th_percentile":127.53,"90th_percentile":1974.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"130","median_amount":477.0,"10th_percentile":384.0,"90th_percentile":949.5,"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":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1913.19,"10th_percentile":1913.19,"90th_percentile":1913.19,"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."}]}]},{"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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"189","median_amount":1279.0,"10th_percentile":325.41,"90th_percentile":2426.4,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"190","median_amount":1301.0,"10th_percentile":303.23,"90th_percentile":2500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":1878.0,"10th_percentile":1878.0,"90th_percentile":1878.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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":82.04,"10th_percentile":82.04,"90th_percentile":82.04,"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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":43.24,"10th_percentile":43.24,"90th_percentile":43.24,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"161","median_amount":46.68,"10th_percentile":42.27,"90th_percentile":120.4,"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":"407","median_amount":101.23,"10th_percentile":99.83,"90th_percentile":262.18,"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":"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":"34","median_amount":45.57,"10th_percentile":23.79,"90th_percentile":117.37,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":"56","median_amount":46.68,"10th_percentile":32.31,"90th_percentile":137.31,"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] [APC ($): FEE SCHEDULE]","count":"49","median_amount":98.04,"10th_percentile":79.87,"90th_percentile":262.55,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":82.06,"10th_percentile":82.06,"90th_percentile":82.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":80.5,"10th_percentile":79.87,"90th_percentile":101.04,"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":"37","median_amount":1498.56,"10th_percentile":585.6,"90th_percentile":2140.8},{"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":91.0,"count":"1 through 10","median_amount":236.42,"10th_percentile":236.42,"90th_percentile":236.42},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":93.22,"10th_percentile":93.22,"90th_percentile":93.22},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":140.74,"10th_percentile":140.74,"90th_percentile":140.74,"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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":1579.5,"10th_percentile":457.5,"90th_percentile":20687.55},{"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":"140","median_amount":913.41,"10th_percentile":209.7,"90th_percentile":2086.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"14","median_amount":938.08,"10th_percentile":154.02,"90th_percentile":1547.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"40","median_amount":696.6,"10th_percentile":431.34,"90th_percentile":4207.53,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":17.93,"10th_percentile":17.93,"90th_percentile":17.93,"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."}]}]},{"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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"76","median_amount":2469.0,"10th_percentile":1403.52,"90th_percentile":3280.8,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"66","median_amount":2191.8,"10th_percentile":1753.44,"90th_percentile":3380.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":116.58,"10th_percentile":116.58,"90th_percentile":116.58,"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":"Centivo","plan_name":"Broad(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":138.69,"10th_percentile":138.69,"90th_percentile":338.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"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":"69","median_amount":335.72,"10th_percentile":119.58,"90th_percentile":338.36,"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":"[APC ($): FEE SCHEDULE]","count":"135","median_amount":135.09,"10th_percentile":115.06,"90th_percentile":322.94,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":335.72,"10th_percentile":335.36,"90th_percentile":335.72,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":"28","median_amount":335.72,"10th_percentile":208.03,"90th_percentile":670.72,"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":"19","median_amount":130.07,"10th_percentile":112.61,"90th_percentile":257.88,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":159.2,"10th_percentile":159.2,"90th_percentile":159.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":182.99,"10th_percentile":182.99,"90th_percentile":866.35,"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":"13","median_amount":3237.12,"10th_percentile":2433.6,"90th_percentile":3362.88},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":70.72,"10th_percentile":70.72,"90th_percentile":70.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"44","median_amount":2158.08,"10th_percentile":1084.16,"90th_percentile":3432.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":2866.2,"10th_percentile":2866.2,"90th_percentile":2866.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"36","median_amount":3034.8,"10th_percentile":1955.0,"90th_percentile":3195.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1988.0,"10th_percentile":1988.0,"90th_percentile":1988.0,"additional_payer_notes":"Contracting method is an algorithm described in 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 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"41","median_amount":1988.38,"10th_percentile":1511.34,"90th_percentile":2326.56,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"34","median_amount":1719.68,"10th_percentile":1380.74,"90th_percentile":2722.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":1988.38,"10th_percentile":1988.38,"90th_percentile":1988.38,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":205.99,"10th_percentile":205.99,"90th_percentile":205.99,"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":"15","median_amount":203.98,"10th_percentile":200.98,"90th_percentile":238.67,"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":"117","median_amount":519.23,"10th_percentile":500.97,"90th_percentile":606.09,"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":"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":200.94,"10th_percentile":200.94,"90th_percentile":401.88,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":200.98,"10th_percentile":200.98,"90th_percentile":206.27,"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] [APC ($): FEE SCHEDULE]","count":"13","median_amount":418.03,"10th_percentile":415.07,"90th_percentile":500.97,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":192.05,"10th_percentile":192.05,"90th_percentile":192.05,"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":415.07,"10th_percentile":415.07,"90th_percentile":484.55,"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":"1 through 10","median_amount":2321.57,"10th_percentile":1099.04,"90th_percentile":4083.84},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"15","median_amount":2149.6,"10th_percentile":1522.0,"90th_percentile":2800.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":2364.56,"10th_percentile":2364.56,"90th_percentile":2364.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":3425.0,"10th_percentile":3425.0,"90th_percentile":3425.0,"additional_payer_notes":"Contracting method is an algorithm described in 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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"38","median_amount":3176.76,"10th_percentile":1217.32,"90th_percentile":4169.71,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"30","median_amount":2819.81,"10th_percentile":1242.0,"90th_percentile":3670.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":225.06,"10th_percentile":127.63,"90th_percentile":315.06,"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":"[APC ($): FEE SCHEDULE]","count":"95","median_amount":252.71,"10th_percentile":170.25,"90th_percentile":415.73,"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":"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":181.2,"10th_percentile":172.52,"90th_percentile":382.89,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":274.62,"10th_percentile":137.31,"90th_percentile":428.14,"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] [APC ($): FEE SCHEDULE]","count":"12","median_amount":326.03,"10th_percentile":166.84,"90th_percentile":360.33,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":134.76,"10th_percentile":133.48,"90th_percentile":329.38,"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":8125.28,"10th_percentile":7486.85,"90th_percentile":8648.06},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":304.16,"10th_percentile":304.16,"90th_percentile":304.16},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":2518.95,"10th_percentile":2518.95,"90th_percentile":2518.95},{"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":"29","median_amount":4503.52,"10th_percentile":801.64,"90th_percentile":7265.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":3758.34,"10th_percentile":2490.18,"90th_percentile":8986.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2523.5,"10th_percentile":2523.5,"90th_percentile":2523.5,"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":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"85","median_amount":3058.01,"10th_percentile":1273.0,"90th_percentile":3696.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"80","median_amount":2764.35,"10th_percentile":1820.41,"90th_percentile":3685.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":267.76,"10th_percentile":267.76,"90th_percentile":474.64,"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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":638.67,"10th_percentile":638.67,"90th_percentile":638.67,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"62","median_amount":539.16,"10th_percentile":130.63,"90th_percentile":648.96,"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":"[APC ($): FEE SCHEDULE]","count":"172","median_amount":250.36,"10th_percentile":134.64,"90th_percentile":476.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":387.66,"10th_percentile":200.94,"90th_percentile":561.6,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":"22","median_amount":539.16,"10th_percentile":259.97,"90th_percentile":885.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":252.04,"10th_percentile":207.35,"90th_percentile":315.19,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":"12","median_amount":279.38,"10th_percentile":248.27,"90th_percentile":486.65,"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":"12","median_amount":3868.7,"10th_percentile":3442.78,"90th_percentile":5036.93},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":5318.29,"10th_percentile":3734.03,"90th_percentile":6261.94},{"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":"43","median_amount":3689.91,"10th_percentile":2051.35,"90th_percentile":4786.78,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":3614.92,"10th_percentile":3614.92,"90th_percentile":13448.6,"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":"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":4975.99,"10th_percentile":4918.86,"90th_percentile":5095.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":3223.96,"10th_percentile":3223.96,"90th_percentile":6385.34,"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."}]}]},{"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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":7042.0,"10th_percentile":7042.0,"90th_percentile":7042.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":1994.88,"10th_percentile":1994.88,"90th_percentile":1994.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":203.98,"10th_percentile":203.98,"90th_percentile":420.54,"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":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":747.59,"10th_percentile":747.59,"90th_percentile":909.51,"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":"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":401.96,"10th_percentile":401.96,"90th_percentile":401.96,"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":"1 through 10","median_amount":598.07,"10th_percentile":598.07,"90th_percentile":598.07,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":598.07,"10th_percentile":598.07,"90th_percentile":598.07,"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":"1 through 10","median_amount":4039.87,"10th_percentile":4039.87,"90th_percentile":4039.87},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":3329.28,"10th_percentile":3329.28,"90th_percentile":3329.28},{"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":1820.58,"10th_percentile":1820.58,"90th_percentile":5382.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":2490.44,"10th_percentile":2490.44,"90th_percentile":2490.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":158.04,"10th_percentile":154.28,"90th_percentile":158.04,"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":393.57,"10th_percentile":220.13,"90th_percentile":596.72,"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":"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":158.04,"10th_percentile":158.04,"90th_percentile":158.04,"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":"1 through 10","median_amount":307.47,"10th_percentile":307.47,"90th_percentile":307.47,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":312.02,"10th_percentile":312.02,"90th_percentile":312.02,"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":2556.0,"10th_percentile":2556.0,"90th_percentile":2556.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":2843.36,"10th_percentile":2843.36,"90th_percentile":3032.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":2322.41,"10th_percentile":2322.41,"90th_percentile":2855.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":203.74,"10th_percentile":194.99,"90th_percentile":341.9,"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":"1 through 10","median_amount":665.68,"10th_percentile":665.68,"90th_percentile":665.68,"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":"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":203.74,"10th_percentile":203.74,"90th_percentile":203.74,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":2369.81,"10th_percentile":2369.81,"90th_percentile":2369.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":6227.33,"10th_percentile":5534.65,"90th_percentile":6607.09,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":6034.92,"10th_percentile":4046.39,"90th_percentile":6435.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":470.3,"10th_percentile":470.3,"90th_percentile":470.3,"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":"1 through 10","median_amount":439.07,"10th_percentile":439.07,"90th_percentile":439.07,"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":"31","median_amount":1258.99,"10th_percentile":1005.99,"90th_percentile":1483.61,"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":"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":462.66,"10th_percentile":462.66,"90th_percentile":462.66,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":462.66,"10th_percentile":439.07,"90th_percentile":462.66,"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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1003.93,"10th_percentile":1003.93,"90th_percentile":1047.23,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":6913.92,"10th_percentile":6913.92,"90th_percentile":6913.92},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":5659.48,"10th_percentile":5426.38,"90th_percentile":5659.48,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":6848.52,"10th_percentile":6594.52,"90th_percentile":9095.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":6084.72,"10th_percentile":5160.99,"90th_percentile":6375.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":600.45,"10th_percentile":600.45,"90th_percentile":600.45,"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":"36","median_amount":1384.19,"10th_percentile":1224.65,"90th_percentile":1540.87,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":597.32,"10th_percentile":597.32,"90th_percentile":597.32,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":597.95,"10th_percentile":597.95,"90th_percentile":597.95,"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":"1 through 10","median_amount":1104.16,"10th_percentile":1104.16,"90th_percentile":1104.16,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":5775.0,"10th_percentile":5775.0,"90th_percentile":5775.0},{"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":"1 through 10","median_amount":5664.06,"10th_percentile":5664.06,"90th_percentile":5923.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":997.57,"10th_percentile":997.57,"90th_percentile":997.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":33925.89,"10th_percentile":33925.89,"90th_percentile":33925.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":186.41,"10th_percentile":186.41,"90th_percentile":186.41,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":600.09,"10th_percentile":277.11,"90th_percentile":4715.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":38852.0,"10th_percentile":38852.0,"90th_percentile":38852.0,"additional_payer_notes":"Contracting method is an algorithm described in 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 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":14194.94,"10th_percentile":14194.94,"90th_percentile":14194.94,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":15765.33,"10th_percentile":15765.33,"90th_percentile":15765.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":750.69,"10th_percentile":750.69,"90th_percentile":750.69,"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 ($): FEE SCHEDULE]","count":"12","median_amount":2567.68,"10th_percentile":2184.62,"90th_percentile":4174.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":10352.29,"10th_percentile":10352.29,"90th_percentile":10352.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":30811.71,"10th_percentile":30811.71,"90th_percentile":30811.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":1368.67,"10th_percentile":1368.67,"90th_percentile":2888.26,"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 ($): FEE SCHEDULE]","count":"17","median_amount":5525.97,"10th_percentile":1369.84,"90th_percentile":7487.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":31986.2,"10th_percentile":28620.96,"90th_percentile":48541.57,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":25095.2,"10th_percentile":25095.2,"90th_percentile":25095.2,"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."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":40519.32,"10th_percentile":40462.86,"90th_percentile":72282.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":55133.72,"10th_percentile":55133.72,"90th_percentile":55133.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":"14","median_amount":7914.6,"10th_percentile":5725.08,"90th_percentile":11496.8,"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":"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":3031.4,"10th_percentile":2354.68,"90th_percentile":4325.8,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":5492.26,"10th_percentile":5492.26,"90th_percentile":10136.35,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"28","median_amount":218.0,"10th_percentile":185.3,"90th_percentile":436.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"23","median_amount":218.0,"10th_percentile":213.24,"90th_percentile":436.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"1 through 10","median_amount":175.0,"10th_percentile":175.0,"90th_percentile":175.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":28.68,"10th_percentile":17.54,"90th_percentile":122.81,"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":"79","median_amount":50.79,"10th_percentile":49.21,"90th_percentile":51.06,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":35.27,"10th_percentile":35.27,"90th_percentile":35.27,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":25.76,"10th_percentile":25.76,"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":"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":42.87,"10th_percentile":40.44,"90th_percentile":50.21,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":55.21,"10th_percentile":55.21,"90th_percentile":55.21,"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":209.28,"10th_percentile":174.72,"90th_percentile":1333.15},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"17","median_amount":166.77,"10th_percentile":139.23,"90th_percentile":676.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":264.88,"10th_percentile":191.84,"90th_percentile":1019.92,"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":"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":638.44,"10th_percentile":638.44,"90th_percentile":638.44,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":715.0,"10th_percentile":714.75,"90th_percentile":1320.05,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":715.0,"10th_percentile":490.8,"90th_percentile":2263.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":37.54,"10th_percentile":35.87,"90th_percentile":184.59,"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 ($): FEE SCHEDULE]","count":"17","median_amount":162.55,"10th_percentile":155.1,"90th_percentile":331.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":124.09,"10th_percentile":124.09,"90th_percentile":124.09,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":1297.92,"10th_percentile":1297.92,"90th_percentile":3191.04},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":2107.5,"10th_percentile":2107.5,"90th_percentile":2107.5},{"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":1137.52,"10th_percentile":572.0,"90th_percentile":1829.12,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1363.12,"10th_percentile":1363.12,"90th_percentile":1363.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":989.36,"10th_percentile":989.36,"90th_percentile":989.36,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":1254.89,"10th_percentile":661.68,"90th_percentile":10060.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":109.82,"10th_percentile":109.82,"90th_percentile":143.75,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":340.78,"10th_percentile":340.38,"90th_percentile":372.23,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":128.28,"10th_percentile":79.32,"90th_percentile":221.95,"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":"1 through 10","median_amount":1090.67,"10th_percentile":1090.67,"90th_percentile":1090.67,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":272.3,"10th_percentile":261.13,"90th_percentile":285.42,"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":459.71,"10th_percentile":362.64,"90th_percentile":2355.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":2445.52,"10th_percentile":2445.52,"90th_percentile":2445.52,"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":"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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":1446.03,"10th_percentile":1446.03,"90th_percentile":1446.03,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"18","median_amount":114.16,"10th_percentile":18.55,"90th_percentile":1273.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":71.84,"10th_percentile":34.94,"90th_percentile":1186.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":354.68,"10th_percentile":125.91,"90th_percentile":1341.57,"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":"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":80.39,"10th_percentile":80.39,"90th_percentile":80.39,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":126.56,"10th_percentile":84.23,"90th_percentile":331.11,"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":"1 through 10","median_amount":275.6,"10th_percentile":275.6,"90th_percentile":275.6,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":547.2,"10th_percentile":502.36,"90th_percentile":997.97},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":741.79,"10th_percentile":741.79,"90th_percentile":741.79},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":80.59,"10th_percentile":80.59,"90th_percentile":80.59,"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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":387.15,"10th_percentile":387.15,"90th_percentile":387.15},{"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":122.49,"10th_percentile":122.49,"90th_percentile":122.49},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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":"26","median_amount":708.48,"10th_percentile":444.8,"90th_percentile":2024.93,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"22","median_amount":4010.44,"10th_percentile":572.76,"90th_percentile":7812.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"25","median_amount":3713.37,"10th_percentile":1046.0,"90th_percentile":5934.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":816.34,"10th_percentile":816.34,"90th_percentile":816.34,"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":"Centivo","plan_name":"Broad(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":378.45,"10th_percentile":128.27,"90th_percentile":654.9,"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":"45","median_amount":613.39,"10th_percentile":199.36,"90th_percentile":4102.7,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":266.41,"10th_percentile":249.43,"90th_percentile":849.73,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":356.06,"10th_percentile":203.22,"90th_percentile":406.44,"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":1008.05,"10th_percentile":718.87,"90th_percentile":6000.2,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":488.77,"10th_percentile":488.77,"90th_percentile":488.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":318.98,"10th_percentile":179.2,"90th_percentile":888.43,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":4589.14,"10th_percentile":4589.14,"90th_percentile":4589.14},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":534.04,"10th_percentile":534.04,"90th_percentile":613.34,"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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":2324.47,"10th_percentile":2324.47,"90th_percentile":4459.78},{"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":4846.02,"10th_percentile":1187.22,"90th_percentile":18302.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":397.22,"10th_percentile":397.22,"90th_percentile":397.22},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":11259.36,"10th_percentile":11259.36,"90th_percentile":25319.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3295.23,"10th_percentile":2670.77,"90th_percentile":3552.53,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"13","median_amount":2772.72,"10th_percentile":2216.16,"90th_percentile":4313.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":2141.25,"10th_percentile":2141.25,"90th_percentile":2141.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":174.83,"10th_percentile":174.83,"90th_percentile":174.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"68","median_amount":451.07,"10th_percentile":147.96,"90th_percentile":1225.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"52","median_amount":1102.5,"10th_percentile":171.52,"90th_percentile":1225.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":63.74,"10th_percentile":27.2,"90th_percentile":65.62,"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":"94","median_amount":148.05,"10th_percentile":142.35,"90th_percentile":268.6,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":64.64,"10th_percentile":51.65,"90th_percentile":102.68,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":63.25,"10th_percentile":34.16,"90th_percentile":73.16,"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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":140.22,"10th_percentile":118.44,"90th_percentile":148.65,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":"11","median_amount":118.44,"10th_percentile":118.44,"90th_percentile":118.44,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":257.28,"10th_percentile":257.28,"90th_percentile":1176.0},{"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":91.0,"count":"1 through 10","median_amount":1172.99,"10th_percentile":1172.99,"90th_percentile":1172.99},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":201.0,"10th_percentile":201.0,"90th_percentile":201.0},{"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":"22","median_amount":749.7,"10th_percentile":205.02,"90th_percentile":980.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1078.0,"10th_percentile":235.84,"90th_percentile":1078.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":239.73,"10th_percentile":239.73,"90th_percentile":239.73,"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":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"18","median_amount":819.89,"10th_percentile":518.4,"90th_percentile":872.46,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"19","median_amount":622.09,"10th_percentile":264.32,"90th_percentile":754.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":92.82,"10th_percentile":92.82,"90th_percentile":99.55,"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":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":294.67,"10th_percentile":285.52,"90th_percentile":308.06,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":72.06,"10th_percentile":72.06,"90th_percentile":92.8,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":93.32,"10th_percentile":89.18,"90th_percentile":117.57,"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":234.88,"10th_percentile":234.88,"90th_percentile":234.88,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":235.73,"10th_percentile":235.73,"90th_percentile":354.17,"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":"1 through 10","median_amount":791.04,"10th_percentile":791.04,"90th_percentile":791.04},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":630.37,"10th_percentile":330.4,"90th_percentile":943.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":950.4,"10th_percentile":950.4,"90th_percentile":1037.52,"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":"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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":4475.0,"10th_percentile":4446.0,"90th_percentile":4475.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":4550.0,"10th_percentile":4472.55,"90th_percentile":4795.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":328.39,"10th_percentile":328.39,"90th_percentile":331.84,"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":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":962.7,"10th_percentile":962.7,"90th_percentile":1099.42,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":328.81,"10th_percentile":328.81,"90th_percentile":328.81,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":328.39,"10th_percentile":328.39,"90th_percentile":328.39,"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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":770.16,"10th_percentile":759.54,"90th_percentile":928.35,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":770.16,"10th_percentile":770.16,"90th_percentile":770.16,"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":"1 through 10","median_amount":4653.12,"10th_percentile":4653.12,"90th_percentile":4653.12},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":3877.6,"10th_percentile":3877.6,"90th_percentile":3877.6,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":929.8,"10th_percentile":929.8,"90th_percentile":929.8,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":240.45,"10th_percentile":240.45,"90th_percentile":1502.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":88.97,"10th_percentile":76.26,"90th_percentile":114.39,"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":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":37.14,"10th_percentile":36.42,"90th_percentile":37.14,"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":"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":58.84,"10th_percentile":14.71,"90th_percentile":94.86,"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":39.64,"10th_percentile":39.64,"90th_percentile":39.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":768.0,"10th_percentile":768.0,"90th_percentile":768.0},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":55.0,"10th_percentile":30.0,"90th_percentile":437.76,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":161.65,"10th_percentile":118.75,"90th_percentile":437.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":56.2,"10th_percentile":56.2,"90th_percentile":121.94,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":26.53,"10th_percentile":26.53,"90th_percentile":26.53,"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":44.96,"10th_percentile":44.96,"90th_percentile":97.55,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":44.96,"10th_percentile":44.96,"90th_percentile":44.96,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":1289.25,"10th_percentile":1289.25,"90th_percentile":1289.25},{"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":523.26,"10th_percentile":523.26,"90th_percentile":523.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":343.2,"10th_percentile":343.2,"90th_percentile":343.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"39","median_amount":897.5,"10th_percentile":151.8,"90th_percentile":2229.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"41","median_amount":1583.8,"10th_percentile":176.55,"90th_percentile":5903.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":451.9,"10th_percentile":451.9,"90th_percentile":451.9,"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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":198.35,"10th_percentile":198.35,"90th_percentile":198.35,"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":"26","median_amount":135.78,"10th_percentile":38.89,"90th_percentile":251.26,"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":"26","median_amount":121.97,"10th_percentile":120.07,"90th_percentile":146.09,"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":"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":40.27,"10th_percentile":37.68,"90th_percentile":190.98,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":12.46,"10th_percentile":12.46,"90th_percentile":46.41,"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":"1 through 10","median_amount":97.58,"10th_percentile":97.58,"90th_percentile":97.58,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":97.58,"10th_percentile":92.81,"90th_percentile":139.64,"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":"1 through 10","median_amount":570.11,"10th_percentile":106.29,"90th_percentile":1820.16},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":804.0,"10th_percentile":804.0,"90th_percentile":1356.0},{"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":"19","median_amount":497.72,"10th_percentile":118.37,"90th_percentile":2357.6,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":430.0,"10th_percentile":155.58,"90th_percentile":2122.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":814.0,"10th_percentile":814.0,"90th_percentile":814.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":686.22,"10th_percentile":686.22,"90th_percentile":686.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":334.08,"10th_percentile":334.08,"90th_percentile":386.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":334.08,"10th_percentile":334.08,"90th_percentile":334.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":35.29,"10th_percentile":35.29,"90th_percentile":35.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":501.12,"10th_percentile":501.12,"90th_percentile":501.12},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electronic Analysis of Devices","code_information":[{"code":"5742","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"13","median_amount":1159.58,"10th_percentile":927.66,"90th_percentile":1243.82,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":1002.88,"10th_percentile":924.0,"90th_percentile":1002.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":26.1,"10th_percentile":26.1,"90th_percentile":29.26,"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":"18","median_amount":86.86,"10th_percentile":86.86,"90th_percentile":87.91,"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":"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":26.26,"10th_percentile":26.1,"90th_percentile":26.26,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":1504.32,"10th_percentile":1504.32,"90th_percentile":1529.32},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"14","median_amount":1078.89,"10th_percentile":898.79,"90th_percentile":1273.6,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1997.42,"10th_percentile":1997.42,"90th_percentile":1997.42,"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":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"29","median_amount":2022.0,"10th_percentile":1011.0,"90th_percentile":3033.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"17","median_amount":1565.0,"10th_percentile":939.0,"90th_percentile":2708.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":334.15,"10th_percentile":334.15,"90th_percentile":334.15,"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":"[APC ($): FEE SCHEDULE]","count":"42","median_amount":448.7,"10th_percentile":179.48,"90th_percentile":807.66,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":128.46,"10th_percentile":128.46,"90th_percentile":128.46,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":458.57,"10th_percentile":393.06,"90th_percentile":458.57,"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":671.93,"10th_percentile":407.19,"90th_percentile":863.91,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":1612.8,"10th_percentile":1612.8,"90th_percentile":1612.8},{"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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":262.04,"10th_percentile":262.04,"90th_percentile":262.04,"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":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":1542.24,"10th_percentile":924.8,"90th_percentile":2150.4,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":398.56,"10th_percentile":398.56,"90th_percentile":398.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"20","median_amount":1022.23,"10th_percentile":90.08,"90th_percentile":2456.48,"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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":1046.0,"10th_percentile":359.21,"90th_percentile":2644.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":90.08,"10th_percentile":90.08,"90th_percentile":90.08,"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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":90.99,"10th_percentile":90.99,"90th_percentile":90.99,"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":"11","median_amount":194.09,"10th_percentile":87.15,"90th_percentile":226.24,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":90.08,"10th_percentile":90.08,"90th_percentile":90.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":1947.89,"10th_percentile":1947.89,"90th_percentile":1947.89},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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":232.71,"10th_percentile":232.71,"90th_percentile":232.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":942.29,"10th_percentile":942.29,"90th_percentile":942.29},{"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":1909.52,"10th_percentile":1909.52,"90th_percentile":1909.52,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":3512.9,"10th_percentile":3512.9,"90th_percentile":3512.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":8688.64,"10th_percentile":8688.64,"90th_percentile":8688.64,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":2740.76,"10th_percentile":2740.76,"90th_percentile":7513.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"127","median_amount":35.0,"10th_percentile":20.0,"90th_percentile":75.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"16","median_amount":65.29,"10th_percentile":30.0,"90th_percentile":100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":84.45,"10th_percentile":84.45,"90th_percentile":84.45,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":57.32,"10th_percentile":55.43,"90th_percentile":57.32,"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":"67","median_amount":121.94,"10th_percentile":121.94,"90th_percentile":161.94,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":57.31,"10th_percentile":55.42,"90th_percentile":85.37,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":132.3,"10th_percentile":132.3,"90th_percentile":132.3},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":69.82,"10th_percentile":69.82,"90th_percentile":103.25,"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":97.55,"10th_percentile":96.03,"90th_percentile":217.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":"47","median_amount":125.76,"10th_percentile":108.48,"90th_percentile":181.12},{"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":75.0,"10th_percentile":75.0,"90th_percentile":75.0},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":119.21,"10th_percentile":119.21,"90th_percentile":119.21},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"51","median_amount":98.25,"10th_percentile":70.25,"90th_percentile":110.25},{"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":"85","median_amount":101.6,"10th_percentile":86.45,"90th_percentile":124.43,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":122.49,"10th_percentile":122.49,"90th_percentile":122.49},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"29","median_amount":115.28,"10th_percentile":30.0,"90th_percentile":147.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"42","median_amount":117.9,"10th_percentile":101.7,"90th_percentile":136.71,"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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":105.32,"10th_percentile":105.32,"90th_percentile":145.52,"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."}]}]},{"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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1181","median_amount":255.83,"10th_percentile":70.74,"90th_percentile":772.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"981","median_amount":252.24,"10th_percentile":74.49,"90th_percentile":671.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":511.0,"10th_percentile":295.52,"90th_percentile":817.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":30.76,"10th_percentile":17.36,"90th_percentile":124.58,"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":"Centivo","plan_name":"Broad(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":151.06,"10th_percentile":151.06,"90th_percentile":151.06,"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":"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] [All Other OP (%BC): 7.51]","count":"17","median_amount":61.54,"10th_percentile":15.71,"90th_percentile":130.74,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"941","median_amount":30.85,"10th_percentile":12.51,"90th_percentile":133.06,"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":"[APC ($): FEE SCHEDULE]","count":"2126","median_amount":30.35,"10th_percentile":13.21,"90th_percentile":87.03,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"212","median_amount":22.54,"10th_percentile":9.71,"90th_percentile":85.81,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":570.4,"10th_percentile":570.4,"90th_percentile":570.4},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"373","median_amount":34.78,"10th_percentile":12.51,"90th_percentile":138.8,"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] [APC ($): FEE SCHEDULE]","count":"315","median_amount":34.58,"10th_percentile":13.75,"90th_percentile":105.15,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":39.33,"10th_percentile":20.64,"90th_percentile":124.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"152","median_amount":34.89,"10th_percentile":13.93,"90th_percentile":76.49,"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":"239","median_amount":465.6,"10th_percentile":102.72,"90th_percentile":1387.2},{"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":50.88,"10th_percentile":50.88,"90th_percentile":75.0},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":576.18,"10th_percentile":375.21,"90th_percentile":966.42},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":177.8,"10th_percentile":21.17,"90th_percentile":871.78},{"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":96.0,"10th_percentile":96.0,"90th_percentile":96.0},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":21.55,"10th_percentile":10.91,"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":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"64","median_amount":188.25,"10th_percentile":78.25,"90th_percentile":711.75},{"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":"950","median_amount":122.82,"10th_percentile":28.93,"90th_percentile":660.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":270.63,"10th_percentile":270.63,"90th_percentile":270.63},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"99","median_amount":271.04,"10th_percentile":50.0,"90th_percentile":990.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"18","median_amount":403.6,"10th_percentile":143.94,"90th_percentile":945.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"20","median_amount":1264.88,"10th_percentile":199.2,"90th_percentile":1548.39,"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."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"184","median_amount":679.0,"10th_percentile":340.8,"90th_percentile":1896.94,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"124","median_amount":730.0,"10th_percentile":273.75,"90th_percentile":1743.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":334.0,"10th_percentile":334.0,"90th_percentile":334.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":151.34,"10th_percentile":151.34,"90th_percentile":151.34,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"172","median_amount":130.88,"10th_percentile":59.16,"90th_percentile":295.8,"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":"306","median_amount":117.47,"10th_percentile":35.44,"90th_percentile":277.87,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":187.14,"10th_percentile":77.86,"90th_percentile":342.65,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":94.14,"10th_percentile":31.38,"90th_percentile":302.1,"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":"50","median_amount":157.97,"10th_percentile":37.98,"90th_percentile":364.67,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":88.19,"10th_percentile":61.65,"90th_percentile":204.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":"30","median_amount":129.08,"10th_percentile":57.25,"90th_percentile":370.58,"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":"35","median_amount":860.16,"10th_percentile":394.56,"90th_percentile":3408.64},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"1 through 10","median_amount":125.33,"10th_percentile":125.33,"90th_percentile":125.33},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":756.0,"10th_percentile":528.75,"90th_percentile":1730.25},{"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":"144","median_amount":750.47,"10th_percentile":274.4,"90th_percentile":2025.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":948.64,"10th_percentile":323.84,"90th_percentile":3149.52,"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":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"203","median_amount":959.2,"10th_percentile":305.28,"90th_percentile":2451.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":451.04,"10th_percentile":451.04,"90th_percentile":451.04,"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."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"152","median_amount":293.04,"10th_percentile":285.3,"90th_percentile":293.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"146","median_amount":288.44,"10th_percentile":280.8,"90th_percentile":288.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":293.04,"10th_percentile":293.04,"90th_percentile":293.04,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"1 through 10","median_amount":30.39,"10th_percentile":30.39,"90th_percentile":30.39,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"34","median_amount":30.07,"10th_percentile":30.04,"90th_percentile":30.07,"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":"182","median_amount":161.92,"10th_percentile":161.55,"90th_percentile":164.03,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":30.07,"10th_percentile":29.62,"90th_percentile":30.07,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":244.0,"10th_percentile":244.0,"90th_percentile":244.0},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":30.04,"10th_percentile":30.04,"90th_percentile":30.07,"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":"12","median_amount":161.92,"10th_percentile":161.92,"90th_percentile":164.02,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":"13","median_amount":84.53,"10th_percentile":84.53,"90th_percentile":86.99,"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":"20","median_amount":292.8,"10th_percentile":285.12,"90th_percentile":292.8},{"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":91.0,"count":"1 through 10","median_amount":105.67,"10th_percentile":105.67,"90th_percentile":105.67},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":228.75,"10th_percentile":228.75,"90th_percentile":228.75},{"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":"101","median_amount":233.33,"10th_percentile":227.21,"90th_percentile":244.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":268.4,"10th_percentile":268.4,"90th_percentile":268.4,"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":"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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":244.0,"10th_percentile":244.0,"90th_percentile":485.87,"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":"Durable Medical Equipment","code_information":[{"code":"N805","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":131.87,"10th_percentile":131.87,"90th_percentile":131.87,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":816.0,"10th_percentile":816.0,"90th_percentile":816.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":68.48,"10th_percentile":68.48,"90th_percentile":68.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":123.55,"10th_percentile":30.39,"90th_percentile":311.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":45.26,"10th_percentile":45.26,"90th_percentile":45.26,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":670.4,"10th_percentile":670.4,"90th_percentile":941.11,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"14","median_amount":255.04,"10th_percentile":92.5,"90th_percentile":2000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"19","median_amount":295.44,"10th_percentile":192.0,"90th_percentile":2432.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":30.07,"10th_percentile":14.02,"90th_percentile":1446.06,"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":"[APC ($): FEE SCHEDULE]","count":"67","median_amount":192.69,"10th_percentile":23.52,"90th_percentile":1800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":33.04,"10th_percentile":33.04,"90th_percentile":33.07,"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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":33.07,"10th_percentile":30.07,"90th_percentile":154.11,"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":"1 through 10","median_amount":129.28,"10th_percentile":129.28,"90th_percentile":129.28,"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":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":100.0,"10th_percentile":100.0,"90th_percentile":100.0},{"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":"11","median_amount":363.39,"10th_percentile":198.91,"90th_percentile":390.4,"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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"1 through 10","median_amount":1251.36,"10th_percentile":1251.36,"90th_percentile":1251.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anesthesia, bundled","code_information":[{"code":"N901","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_payer_notes":"No 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14.21,"10th_percentile":14.21,"90th_percentile":14.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":189.9,"10th_percentile":189.9,"90th_percentile":189.9,"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":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"1 through 10","median_amount":68.53,"10th_percentile":68.53,"90th_percentile":111.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":14.96,"10th_percentile":12.51,"90th_percentile":20.33,"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":48.34,"10th_percentile":48.34,"90th_percentile":48.34,"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":"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":16.85,"10th_percentile":14.48,"90th_percentile":19.88,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_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":17.41,"10th_percentile":8.03,"90th_percentile":61.56,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":176.64,"10th_percentile":176.64,"90th_percentile":176.64},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":88.0,"10th_percentile":88.0,"90th_percentile":92.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"1 through 10","median_amount":114.0,"10th_percentile":114.0,"90th_percentile":114.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization 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 ($): 3886] [Cardiac Cath ($): 17425] [Lithotripsy ($): 23269] [PTCA ($): 37409] [Observation ($): 12067] [ED Level 1--99281 ($): 317] [ED Level 2--99282 ($): 317] [ED Level 3--99283 ($): 1046] [ED Level 4--99284 ($): 5631] [ED Level 5--99285 ($): 5631] [Critical Care-99291 ($): 10457] [Urgent Care ($): 401] [Cardiac Rehabilitation Therapy ($): 313] [Sleep Studies-Attended ($): 4550] [Sleep Studies-Unattended ($): 1174] [CT Scan OP ($): 3275] [MRI OP ($): 3510] [Mammography-Diagnostic ($): 416] [Mammography-Screening ($): 416] [Positron Emission Tomography ($): 5414] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1774] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 365] [Physical Therapy ($): 349] [Speech Therapy ($): 259] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 64] [All Other OP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4313] [Cardiac Cath ($): 17093] [Lithotripsy ($): 22826] [PTCA ($): 36699] [Observation ($): 12286] [ED Level 1--99281 ($): 342] [ED Level 2--99282 ($): 342] [ED Level 3--99283 ($): 1273] [ED Level 4--99284 ($): 7042] [ED Level 5--99285 ($): 7042] [Critical Care-99291 ($): 10539] [Urgent Care ($): 601] [Cardiac Rehabilitation Therapy ($): 337] [Sleep Studies-Attended ($): 4475] [Sleep Studies-Unattended ($): 1264] [CT Scan OP ($): 3516] [MRI OP ($): 4439] [Mammography-Diagnostic ($): 447] [Mammography-Screening ($): 447] [Positron Emission Tomography ($): 5819] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1906] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 435] [Physical Therapy ($): 408] [Speech Therapy ($): 335] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 74] [All Other OP (%BC): 74]","count":"0","additional_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(WI1) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4693] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 32333] [Insertion of Permanent Pacemaker ($): 27654] [Joint Replacement-Full/Partial ($): 20661] [PTCA w/ Drug Eluting Stent ($): 30076] [PTCA w/non Drug Eluting Stent ($): 29800] [PTCA w/out stent ($): 24846] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 11275] [ED Level 1--99281 ($): 600] [ED Level 2--99282 ($): 600] [ED Level 3--99283 ($): 3200] [ED Level 4--99284 ($): 4050] [ED Level 5--99285 ($): 5175] [Critical Care ($): 7225] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 311] [Cardiac Stress Test ($): 917] [Cardiology ($): 528] [Echocardiology ($): 2313] [EKG/ECG ($): 209] [Electrophysiology ($): 19581] [Electrophysiology Ablation ($): 62836] [Electrophysiology and Mapping Studies ($): 53641] [Holter Monitor/Telemetry ($): 1347] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1246] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 371] [Sleep Studies-Attended ($): 4750] [Sleep Studies-Unattended ($): 1190] [Chemotherapy ($): 700] [Nuclear Medicine ($): 3518] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2550] [MRI OP ($): 2962] [Imaging Services ($): 445] [Mammography-Diagnostic ($): 330] [Mammography-Screening ($): 330] [Positron Emission Tomography ($): 5904] [Radiology ($): 467] [Ultrasound Imaging ($): 675] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 823] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 411] [Physical Therapy ($): 416] [Respiratory Services/Therapy  (%BC): 278] [Speech Therapy ($): 275] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 366] [Pulmonary Function ($): 1175] [Pulmonary Rehabilitation ($): 139] [All Other OP (%BC): 83]","count":"0","additional_payer_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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4376] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30151] [Insertion of Permanent Pacemaker ($): 25787] [Joint Replacement-Full/Partial ($): 19266] [PTCA w/ Drug Eluting Stent ($): 28046] [PTCA w/non Drug Eluting Stent ($): 27789] [PTCA w/out stent ($): 23169] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 10514] [ED Level 1--99281 ($): 560] [ED Level 2--99282 ($): 560] [ED Level 3--99283 ($): 2984] [ED Level 4--99284 ($): 3777] [ED Level 5--99285 ($): 4826] [Critical Care ($): 6737] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 290] [Cardiac Stress Test ($): 855] [Cardiology ($): 492] [Echocardiology ($): 2157] [EKG/ECG ($): 195] [Electrophysiology ($): 18259] [Electrophysiology Ablation ($): 58595] [Electrophysiology and Mapping Studies ($): 50020] [Holter Monitor/Telemetry ($): 1256] [Peripheral Vascular Lab ($): 1119] [EEG ($): 1162] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 346] [Sleep Studies-Attended ($): 4429] [Sleep Studies-Unattended ($): 1110] [Chemotherapy ($): 653] [Nuclear Medicine ($): 3281] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2378] [MRI OP ($): 2762] [Imaging Services ($): 415] [Mammography-Diagnostic ($): 308] [Mammography-Screening ($): 308] [Positron Emission Tomography ($): 5505] [Radiology ($): 435] [Ultrasound Imaging ($): 629] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 767] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 383] [Physical Therapy ($): 388] [Respiratory Services/Therapy  (%BC): 259] [Speech Therapy ($): 256] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 341] [Pulmonary Function ($): 1096] [Pulmonary Rehabilitation ($): 130] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4282] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 29504] [Insertion of Permanent Pacemaker ($): 25234] [Joint Replacement-Full/Partial ($): 18853] [PTCA w/ Drug Eluting Stent ($): 27444] [PTCA w/non Drug Eluting Stent ($): 27193] [PTCA w/out stent ($): 22672] [Stereotactic Radiosurgery (%BC): 78] [Stereotactic Radiosurgery-Fractionated (%BC): 78] [Observation ($): 10288] [ED Level 1--99281 ($): 548] [ED Level 2--99282 ($): 548] [ED Level 3--99283 ($): 2920] [ED Level 4--99284 ($): 3696] [ED Level 5--99285 ($): 4722] [Critical Care ($): 6593] [Urgent Care (%BC): 78] [Cardiac Rehabilitation Therapy ($): 284] [Cardiac Stress Test ($): 837] [Cardiology ($): 482] [Echocardiology ($): 2111] [EKG/ECG ($): 191] [Electrophysiology ($): 17868] [Electrophysiology Ablation ($): 57338] [Electrophysiology and Mapping Studies ($): 48947] [Holter Monitor/Telemetry ($): 1229] [Peripheral Vascular Lab ($): 1095] [EEG ($): 1137] [EMG (%BC): 78] [MEG (%BC): 78] [Neuropsychological Testing and Biofeedback ($): 339] [Sleep Studies-Attended ($): 4334] [Sleep Studies-Unattended ($): 1086] [Chemotherapy ($): 639] [Nuclear Medicine ($): 3210] [Oncology (%BC): 78] [Radiation Therapy  (%BC): 78] [CT Scan OP ($): 2327] [MRI OP ($): 2703] [Imaging Services ($): 406] [Mammography-Diagnostic ($): 301] [Mammography-Screening ($): 301] [Positron Emission Tomography ($): 5387] [Radiology ($): 426] [Ultrasound Imaging ($): 616] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 751] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 78] [Occupational Therapy ($): 375] [Physical Therapy ($): 380] [Respiratory Services/Therapy  (%BC): 254] [Speech Therapy ($): 251] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 78] [Ambulance--Land  (%BC): 78] [Hyperbarics (%BC): 78] [IV Therapy ($): 334] [Pulmonary Function ($): 1072] [Pulmonary Rehabilitation ($): 127] [All Other OP (%BC): 78]","count":"0","additional_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] [All Other OP (%BC): 7.51]","count":"0","additional_payer_notes":"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":63.95,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":63.95,"10th_percentile":63.95,"90th_percentile":63.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_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":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_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 Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_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":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"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): 88] [Observation (%BC): 88] [Emergency Department (%BC): 88] [Occupational Therapy (%BC): 88] [Physical Therapy (%BC): 88] [Respiratory Services/Therapy  (%BC): 88] [Speech Therapy (%BC): 88] [All Other OP (%BC): 88]","count":"0","additional_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): 73.10] [Observation (%BC): 73.10] [Emergency Department (%BC): 73.10] [Occupational Therapy (%BC): 73.10] [Physical Therapy (%BC): 73.10] [Respiratory Services/Therapy  (%BC): 73.10] [Speech Therapy (%BC): 73.10] [OP High Cost Drugs (%BC): 63.50] [All Other OP (%BC): 73.10]","count":"0","additional_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): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [OP High Cost Drugs (%BC): 73.10] [All Other OP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 63.50] [All Other IP (%BC): 73.10]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 73.10] [All Other IP (%BC): 80]","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":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2652] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 17295 Days: 4 Additional Days: 2157] [Normal vag. Del. 4 day stay-Case Rate: 9976 Days: 4 Additional Days: 2157] [Normal Newborn-Per Diem: 1243] [Lower Level Neonate-Per Diem: 1343] [Higher Level Neonate-Per Diem: 1679] [Severe Level Neonate-per diem: 1679] [Rehab (%BC): 64] [All Other IP (%BC): 64]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 2942] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 18841 Days: 4 Additional Days: 1976] [Normal vag. Del. 4 day stay-Case Rate: 10076 Days: 4 Additional Days: 1976] [Normal Newborn-Per Diem: 1417] [Lower Level Neonate-Per Diem: 1619] [Higher Level Neonate-Per Diem: 1913] [Severe Level Neonate-per diem: 1913] [Rehab (%BC): 74] [All Other IP (%BC): 74]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7155] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 16400 Days: 4 Additional Days: 1575] [Normal vag. Del. 2 day stay-Case Rate: 9450 Days: 2 Additional Days: 1575] [Normal Newborn-Per Diem: 1400] [Lower Level Neonate-Per Diem: 2550] [Higher Level Neonate-Per Diem: 3650] [Severe Level Neonate-per diem: 4050] [Psych-Per Diem: 1624] [Rehab-Per Diem: 2311] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6672] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 15293 Days: 4 Additional Days: 1469] [Normal vag. Del. 2 day stay-Case Rate: 8812 Days: 2 Additional Days: 1469] [Normal Newborn-Per Diem: 1306] [Lower Level Neonate-Per Diem: 2378] [Higher Level Neonate-Per Diem: 3404] [Severe Level Neonate-per diem: 3777] [Psych-Per Diem: 1514] [Rehab-Per Diem: 2155] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI3) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 6529] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 14965 Days: 4 Additional Days: 1437] [Normal vag. Del. 2 day stay-Case Rate: 8623 Days: 2 Additional Days: 1437] [Normal Newborn-Per Diem: 1278] [Lower Level Neonate-Per Diem: 2327] [Higher Level Neonate-Per Diem: 3331] [Severe Level Neonate-per diem: 3696] [Psych-Per Diem: 1482] [Rehab-Per Diem: 2109] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health Partners Inc.","plan_name":"Anderson Corporation Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Inculsa","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":91.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz Health Solutions","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"TriWest","plan_name":"Government","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 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session","code_information":[{"code":"G0421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.72,"maximum":26.29,"payers_information":[{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.29,"additional_payer_notes":"APC"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.72,"additional_payer_notes":"APC"}]}]},{"description":"PPPS, initial visit","code_information":[{"code":"G0438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.24,"maximum":166.99,"payers_information":[{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":166.99,"additional_payer_notes":"APC"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":125.24,"additional_payer_notes":"APC"}]}]},{"description":"PPPS, subseq visit","code_information":[{"code":"G0439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.78,"maximum":131.7,"payers_information":[{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":131.7,"additional_payer_notes":"APC"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.78,"additional_payer_notes":"APC"}]}]},{"description":"Initial care training 30 m","code_information":[{"code":"G0539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.44,"maximum":39.26,"payers_information":[{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.26,"additional_payer_notes":"APC"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.44,"additional_payer_notes":"APC"}]}]},{"description":"Train for caregiver add 15","code_information":[{"code":"G0540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.69,"maximum":20.92,"payers_information":[{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.92,"additional_payer_notes":"APC"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.69,"additional_payer_notes":"APC"}]}]},{"description":"Safety plan interven","code_information":[{"code":"G0560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.3,"maximum":39.07,"payers_information":[{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.07,"additional_payer_notes":"APC"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.3,"additional_payer_notes":"APC"}]}]},{"description":"Remot img sub by pt, non e/m","code_information":[{"code":"G2250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.78,"maximum":7.71,"payers_information":[{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"APC"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"}]}]},{"description":"Brief chkin, 5-10, non-e/m","code_information":[{"code":"G2251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.78,"maximum":10.37,"payers_information":[{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.37,"additional_payer_notes":"APC"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.78,"additional_payer_notes":"APC"}]}]},{"description":"Brief chkin by md/qhp, 11-20","code_information":[{"code":"G2252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.95,"maximum":21.27,"payers_information":[{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"APC"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"}]}]},{"description":"Removable soft interface le","code_information":[{"code":"K0672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.16,"maximum":104.22,"payers_information":[{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104.22,"additional_payer_notes":"APC"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.16,"additional_payer_notes":"APC"}]}]},{"description":"Aud osseo dev, abutment","code_information":[{"code":"L8693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1400.35,"maximum":1867.13,"payers_information":[{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1867.13,"additional_payer_notes":"APC"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1400.35,"additional_payer_notes":"APC"}]}]},{"description":"Ext antenna phren nerve stim","code_information":[{"code":"L8696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.14,"maximum":266.86,"payers_information":[{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.86,"additional_payer_notes":"APC"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200.14,"additional_payer_notes":"APC"}]}]}],"modifier_information":[{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"BCBS","plan_name":"Blue Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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":"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":"Medicare 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":"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":"Health Partners Inc.","plan_name":"Anderson Corporation 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":"Inculsa","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":"Molina","plan_name":"Medicaid 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 Health Solutions","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest","plan_name":"Government","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":"Workers Comp","plan_name":"Workers Compensation Plan","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":"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 Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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":"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":"Medicare 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":"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":"Health Partners Inc.","plan_name":"Anderson Corporation 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":"Inculsa","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":"Molina","plan_name":"Medicaid 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 Health Solutions","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest","plan_name":"Government","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":"Workers Comp","plan_name":"Workers Compensation Plan","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":"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 Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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":"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":"Medicare 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":"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":"Health Partners Inc.","plan_name":"Anderson Corporation 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":"Inculsa","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":"Molina","plan_name":"Medicaid 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 Health Solutions","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest","plan_name":"Government","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":"Workers Comp","plan_name":"Workers Compensation Plan","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":"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 Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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":"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":"Medicare 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":"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":"Health Partners Inc.","plan_name":"Anderson Corporation 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":"Inculsa","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":"Molina","plan_name":"Medicaid 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 Health Solutions","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest","plan_name":"Government","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":"Workers Comp","plan_name":"Workers Compensation Plan","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":"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 Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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":"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":"Medicare 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":"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":"Health Partners Inc.","plan_name":"Anderson Corporation 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":"Inculsa","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":"Molina","plan_name":"Medicaid 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 Health Solutions","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest","plan_name":"Government","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":"Workers Comp","plan_name":"Workers Compensation Plan","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":"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 Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI1) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI3) 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":"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":"Medicare 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":"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":"Health Partners Inc.","plan_name":"Anderson Corporation 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":"Inculsa","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":"Molina","plan_name":"Medicaid 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 Health Solutions","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"TriWest","plan_name":"Government","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":"Workers Comp","plan_name":"Workers Compensation Plan","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":"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."}]}]}